Lyme disease: symptoms, tick bite signs, testing, and treatment

 

Lyme disease cases have steadily risen since data collection began in 2015. In 2021, there were 1,156 laboratory-confirmed cases in England and Wales. It's also estimated that between 1,000 and 2,000 additional cases are diagnosed each year by doctors without testing [1]. 

Infections now occur regularly in many parts of the UK and infected ticks have been found in every region. So, if you’re planning to enjoy the great outdoors this summer, it’s important to take steps to protect yourself. 

We look at how you can avoid tick bites, recognise the signs and symptoms of infection, and when to seek medical assistance.

• What is Lyme disease?
• What are the symptoms of Lyme disease?
• How do I know if I have Lyme disease?
• Lyme disease complications
• How is Lyme disease treated?
• When should I get medical help?
• Where am I at risk?
• Why are cases of Lyme disease on the rise in the UK?
• Is Lyme disease contagious?
• Is Lyme disease curable?
• How to avoid tick bites
• How to remove a tick
• Enjoy the outdoors safely

What is Lyme disease?
 

Lyme disease is an infection commonly caused by the bacterium, Borrelia burgdorferi. This bacterium is spread to humans by bites from infected ticks — tiny, brownish, spider-like creatures that feed on the blood of birds and mammals, including humans.  Once a tick has fed, it increases in size, and changes to a greyish colour.

Not all ticks carry the infection and not all bites from infected ticks result in transmission. However, it’s important to be aware of the risks of tick bites and take action to avoid them. If Lyme disease is left untreated, it can lead to serious health conditions, including problems with your nervous system or heart. 

What are the symptoms of Lyme disease?
 

One of the most common signs of Lyme disease is a spreading circular or oval 'bullseye' rash that can develop 3 to 30 days after a tick bite, although not everyone gets a rash. If a rash does develop, it's important to take a photo of it to show to your doctor, as it can quickly disappear.

Early signs of infection include:

• A high temperature (fever)Chills
• Feeling tired all the time (fatigue)
• Headaches 
• Muscle and joint pain 
• Neck stiffness

Other symptoms can include nerve pain, facial droop, and numbness or tingling in your hands or feet.

How do I know if I have Lyme disease?
 

NICE recommends diagnosing Lyme disease clinically in people with the typical spreading rash, without waiting for laboratory testing. If there is a suspicion of Lyme disease without a rash, an ELISA blood test is recommended, with antibiotics being considered while waiting for the result [2].

Our Lyme Disease ELISA Blood Test checks for antibodies against Borrelia burgdorferi, the most common bacterium to cause the infection. 

This test is most sensitive at the six-week mark, and a negative result before six weeks, if you have symptoms or exposure concerns, may need to be repeated after six weeks. Earlier treatment generally has better outcomes, and tests can be positive before six weeks, allowing treatment to be given early.

If you don’t have any symptoms, wait at least six weeks after any suspected exposure before testing. It takes time for the antibodies to reach detectable levels, meaning you may receive a false-negative result if the blood test is taken too soon. 

It’s possible to have a positive test result when you don’t have the infection (a false-positive result). This is more likely to happen if you have glandular fever, rheumatoid arthritis, or another autoimmune condition.

If you receive a positive result, your doctor may arrange an immunoblot (IgG Western Blot) confirmation test. 

If you’re experiencing any symptoms, you should see your doctor immediately. A diagnosis of Lyme disease is based on tests, a physical examination, and your symptoms. There’s no conclusive test for Lyme disease, so it cannot be diagnosed through a blood test alone. 

Lyme disease complications
 

If an infection is left untreated, or not treated early, bacteria can multiply and spread. This can affect many areas of the body such as joints, the heart, and the nervous system.

Complications of Lyme disease include:

• Difficulty concentrating
• Heart problems
• Memory problems
• Nerve problems such as numbness or pain in your limbs
• Pain and swelling in your joints
• Sight and hearing problems

Some people go on to develop long-term symptoms similar to those of fibromyalgia or chronic fatigue syndrome. It’s not known exactly why this happens and it’s likely related to overactivity of the immune system rather than continued infection.

How is Lyme disease treated?
 

Lyme disease is a bacterial infection that is usually treated with antibiotics. Most people recover completely, especially when treatment starts early. Prompt treatment helps reduce the risk of the infection spreading and lowers the chance of further symptoms or complications affecting the joints, nervous system, or heart. Currently, there’s no vaccine licensed for human use, although some are in development.

When should I get medical help?

 
Seek medical advice if you develop a rash, flu-like symptoms, fatigue, headache, muscle or joint pain after a tick bite or spending time outdoors in grassy or wooded areas. It’s also important to speak to a doctor if symptoms continue, get worse, or you notice signs such as facial drooping, nerve pain, numbness, or heart-related symptoms. Early assessment can help you get the right treatment sooner.

 

Where am I at risk?
 

Ticks are usually found in woodland, heathlands, and grassy areas. So, you’re more at risk of being bitten if you enjoy outdoor activities like hiking, cycling, and camping. You might also encounter ticks while walking in other green spaces like urban parks and gardens.

Ticks are usually most active from April to July, and sometimes later in the autumn. Although they’re much less active in the winter months, they may still be on the lookout for food. So, it’s important to take precautions to avoid bites at any time of year.

The UK Health Security Agency (UKHSA) advises checking yourself, your clothing, your pets, and other people for ticks after spending time outdoors [3].

Why are cases of Lyme disease on the rise in the UK?
 

The rise in cases is probably due to a combination of factors, including increased awareness of the infection and better access to diagnostics.

Tick populations are also growing and becoming more widespread. Climate change is thought to be one of the drivers behind increasing tick numbers, with warmer temperatures creating more suitable habitats for them to thrive [4]. 

Is Lyme disease contagious?
 

Lyme disease cannot be spread from one person to another. Transmission of the bacterium from an infected pregnant woman to a foetus is possible but very rare.

Is Lyme disease curable?
 

Most people with Lyme disease get better after a course of antibiotics. But even after treatment, some people continue to have symptoms for months or even years later.

These can include fatigue, joint pain, and stiffness. However, they usually improve over time. Early diagnosis and treatment can help prevent more severe symptoms and complications.

How to avoid tick bites
 

If you’re planning to spend time in woodland or grassland areas, there are some simple precautions you can take to avoid tick bites.

Top tips for avoiding tick bites:

• Wear clothes that cover your skin and tuck your trousers into your socks.
• Use an insect repellent that contains DEET.
• Wear light-coloured clothes to make spotting ticks as easy as possible.
• Stick to paths and avoid brushing against long grass or other vegetation where ticks might be present (ticks can’t fly or jump, so they hitch a ride on animals or humans as they brush past).
• Regularly check your clothing and exposed skin for ticks and brush them off immediately.

It’s important to be vigilant as ticks are very small (about the size of a pinhead), unless fed. Then they increase in size, and change from a dark brown to greyish in colour. Their saliva has anaesthetic properties, so you probably won’t notice if you’ve been bitten. 

How to remove a tick
 

If you’ve been bitten by a tick, try to remove it as soon as possible to reduce the risk of getting a tick-borne infection.

Four steps to remove ticks:

1. Using fine-tipped tweezers, gently grip the tick as close to your skin as possible to ensure you remove the head and mouth. Pull the tick steadily away from your skin, without twisting or crushing it.
2. Alternatively, tick-removal tools are widely available in pet shops and pharmacies, and are designed to remove the complete tick easily. 
3. After you’ve removed the tick, wash your skin with soap and water.
4. Apply an antiseptic cream to the skin around the bite.

Once the tick is removed, keep an eye on the area where you were bitten. If you develop any Lyme disease symptoms, see your doctor.

Enjoy the outdoors safely

Now you know all about prevention and early detection, there’s no reason why Lyme disease should stop you from enjoying time outdoors, and as vitamin D deficiency is a common problem in the UK, it’s good for your health, too. 

Take precautions to avoid tick bites and look out for any warning signs of infection so you can take prompt action. Lyme Disease UK has more advice and guidance for keeping yourself safe this summer.

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References

1. GOV.UK. (2022) Lyme disease epidemiology and surveillance. (Accessed 8 April 2026)
2. National Institute for Health and Care Excellence (2018) Lyme disease: recommendations. (Accessed: 8 April 2026).
3. UK Health Security Agency (2024) What is Lyme disease and why do we need to be tick-aware? (Accessed: 8 April 2026).
4. Li, S., Gilbert, L., Vanwambeke, S., Yu, J., Purse, B. and Harrison, P. (2019) Lyme Disease Risks in Europe under Multiple Uncertain Drivers of Change. Environmental Health Perspectives, 127(6), p.067010.