Borrelia Persistence: The “Third Rail” of Lyme Disease

Borrelia persistence remains one of the most debated and controversial questions in Lyme disease. A growing number of researchers are now examining whether the bacteria can remain active after standard antibiotic treatment in patients who continue to experience symptoms.

The working group, led by Dr. John Aucott of the Johns Hopkins Lyme Disease Clinical Research Center, released its first report in 2018, highlighting the “serious and growing threat of tick-borne diseases.”

The authors called on the government to invest more funding in research, prevention, and treatment.

In a Science article, Jennifer Couzin-Frankel describes what she calls “the third rail of Lyme disease: how Borrelia bacteria persist.”

“Foundations are keen to address the third rail of Lyme disease: how Borrelia bacteria persist—if they do—in treated patients who don’t get better,” she writes.

Funding Efforts to Study Borrelia Persistence

Several major foundations have supported research into whether Borrelia bacteria remain active following standard antibiotic treatment:

• The Steven & Alexandra Cohen Foundation has invested more than $42 million in Lyme and other tick-borne diseases since 2015.
• The Global Lyme Alliance and Bay Area Lyme Foundation have together contributed more than $20 million.

In 2018, the National Institutes of Health (NIH) spent $23 million on Lyme disease research, though it remains unclear how much was directed toward studying bacterial persistence.

Shortly after the working group’s report, the NIH issued a $6 million funding opportunity focused on prevention in tick-borne diseases—representing a notable increase in attention to this area.

Why Borrelia Persistence Matters

The question of whether Borrelia bacteria can persist after treatment has significant implications for patients with ongoing symptoms.

Understanding persistence may help explain why some individuals do not fully recover and may guide future approaches to diagnosis and treatment.

This remains one of the most important—and controversial—areas in Lyme disease research.

Clinical Perspective

The persistence question continues to shape how clinicians approach patients with ongoing symptoms following Lyme disease.

When symptoms persist, clinicians must consider multiple possibilities, including immune response, tissue injury, and the potential for ongoing infection.

Learn More About Persistent Lyme Disease

Explore how ongoing symptoms are evaluated and managed in Lyme disease recovery and persistent illness.

Dr. Daniel Cameron, MD, MPH
Lyme disease clinician with over 30 years of experience and past president of ILADS.

Symptoms • Testing • Coinfections • Recovery • Pediatric • Prevention