Is Lyme Disease Curable?

Lyme disease is curable. Most people who are infected with the tick-borne illness make a full recovery after treatment with antibiotics.

However, a small percentage of those infected by the bacterium that causes Lyme disease, Borrelia burgdorferi (B. burgdorferi), can have lingering symptoms or complications for months or longer.

This article discusses how early detection is the best way to ensure a full recovery. It also details treatment options, potential long-term complications of Lyme disease, and how to prevent this infection.

Stages of Lyme Disease

Lyme disease is a bacterial infection transmitted through the bite of an infected black-legged (deer) tick. In humans, the infection has three stages:

• Stage 1: Early localized Lyme disease symptoms appear within 30 days of a tick bite and include a bulls-eye rash at the site of the bite and low-grade fever. 
• Stage 2: Early disseminated disease is characterized by multiple lesions (that typically occur days to weeks after infection) and/or neurologic and/or cardiac findings (that typically occur weeks to months after infection).
• Stage 3: Late persistent Lyme disease is typically associated with intermittent or persistent arthritis involving one or a few large joints, especially the knee (sometimes preceded by migratory arthralgias), and/or certain rare neurologic problems, primarily a subtle encephalopathy or polyneuropathy. 

When detected and treated in the early stages, most people with Lyme disease make a complete recovery. Lyme disease that progresses to stage 3 is more difficult to treat and can lead to long-term complications.

Stage 1 Treatment

Early-stage Lyme disease is typically treated with a 10- to 14-day course of oral antibiotics. Such medications include:

• Doxycycline
• Amoxicillin
• Cefuroxime

Treatment for stage 1 Lyme disease may be prescribed based on symptoms. In the early stages, the most common symptom is a bullseye rash. known as Erythema migrans. About 90% of people with Lyme disease develop this rash within three to 30 days after being bitten.

If you know you were bitten by a tick in a region with a relatively high risk of Lyme disease, your healthcare provider may not wait to see if a bullseye rash develops. In some cases, you may be prescribed antibiotics immediately. In most cases, a tick must be attached for 36 to 48 hours or more before the Lyme disease bacterium can be transmitted.

In cases where you removed the tick or had a healthcare provider remove it, you might consider testing the parasitic arachnid (note: ticks are not insects). If the Lyme disease bacterium is detected in the tick, your healthcare provider may start you on antibiotics.

Stage 2 Treatment

In stage 2 early disseminated Lyme disease, which occurs weeks to months after the bite, bacteria have spread out to other parts of the body. The nervous and cardiovascular systems may be impacted at this point. You may be first diagnosed at this stage, or you may reach this stage if antibiotic treatment in stage 1 wasn't successful.

A more aggressive antibiotic treatment is recommended for those with stage 2 Lyme disease. A 14-21 day cycle of oral doxycycline, amoxicillin, cefuroxime, or azithromycin (another common antibiotic) may be prescribed.

Treatment for more severe Lyme disease typically requires intravenous (IV) antibiotics for 14 to 21 days.

In addition, you may receive treatment to manage or eradicate neurological symptoms brought on by Lyme disease. These include:

• Bell’s palsy: This condition results in facial muscle paralysis, which usually resolves on its own, but is also treated with steroids.
• Meningitis This is an inflammation of the membranes and fluid that surround the brain and spinal cord. You may be prescribed medication to control fever, stiff neck, and severe headache.
• Neuropathy: Weakness, numbness, and pain usually in the hands and feet, this condition may be managed with over-the-counter pain medication and creams.

If you experience these symptoms, talk to your healthcare provider right away.

Stage 3 Treatment

For those who are not diagnosed and treated early on or who do not respond to antibiotic treatment, more significant symptoms can begin months or years after the bite. Your healthcare provider may try a different antibiotic for 28 days or move from pills to IV antibiotics for 14-28 days.

Research shows that there is no benefit to increased dosage or long-term antibiotic treatment for those whose symptoms persist. However, studies have indicated that most people eventually feel well and symptoms resolve without additional treatment.

As in other stages of the disease, the late persistent stage of Lyme disease can leave you with neurological issues that have to be treated or managed. Vision problems are not uncommon, for instance, among people with stage 3 Lyme disease.

Treatment for Complications

Roughly one in 10 people with Lyme disease end up with post-treatment Lyme disease syndrome (PTLDS) and have ongoing symptoms after treatment. In addition, one in 100 people with Lyme disease develops a more severe complication known as Lyme carditis.

Post-Treatment Lyme Disease Syndrome

PTLDS symptoms are similar to those in the early stages of Lyme disease and include:

• Aching joints or muscles
• Decreased short-term memory
• Fatigue
• Pain
• Joint pain or swelling
• Restless sleep
• Speech problems
• Trouble concentrating

PTLDS symptoms can last for longer than six months and typically resolve over time.

There is no proven treatment for PTLDS. Studies have not found short-term antibiotic treatment effective, and long-term antibiotic treatment can have serious, negative health effects.

Most people with PTLDS do get better over time, but it can take several months for a complete recovery.  

Lyme Carditis 

Lyme carditis is a serious complication that develops when bacteria enter the heart tissues. Bacteria can interfere with electrical signals that control the beating of the heart.

Symptoms of Lyme carditis may include: 

• Chest pain
• Fainting
• Heart palpitations
• Lightheadedness
• Shortness of breath

If you develop Lyme carditis, your healthcare provider may prescribe oral or IV antibiotics depending on the severity of your case. Some people with Lyme carditis may require a temporary pacemaker.

Most people recover fully from Lyme carditis within one to six weeks. Lyme carditis can be fatal, although with 11 cases of fatal Lyme carditis between 1985 and 2019, it is rare.

Prevention

Limiting your exposure to ticks is the best prevention of Lyme disease. Cases have been reported in nearly all U.S states, but it is most common in the Northeast, upper Midwest, and Northwestern states.

Although Lyme disease can happen any time of year, ticks are most active between April and October. Spending time in grassy and heavily wooded areas increases your risk of exposure. If you are going into the woods, the CDC advises wearing long sleeves and pants, tucking your pants into your socks, and treating your clothing and gear with products containing 0.5% permethrin.

You should also apply tick repellant to your skin and clothes prior to spending time in the woods and try to stay in the center of the trails. Ingredients proven to repel ticks include:

• DEET
• Picaridin
• IR3535
• Oil of Lemon Eucalyptus (OLE)
• Para-menthane-diol (PMD)
• 2-undecanone
  

If you are spending a lot of time outdoors or in the woods, reapply tick repellant every six hours.

Checking for Ticks

After leaving potentially tick-infested areas, check your clothing, gear, and pets. If you find any ticks, remove them before entering your home.

Once inside, conduct a full body check for ticks using a full-length or handheld mirror to view your back. If you share your home with family members, you might consider enlisting their help.

Common places ticks can hide include:

• Around your waist
• Back of the knees
• Between your legs
  
• In and around the ears
• In and around the hair
• Inside belly button
• Inside folds of skin
• Under the arms

In addition, take a shower. Rinsing off within two hours of coming indoors has been shown to reduce the risk of Lyme disease.

Removing Ticks

If you find a tick attached to your skin, remove it as soon as possible. In order for you to contract Lyme disease, a tick typically needs to remain attached to you for 36 to 48 hours.

To remove a tick, use fine-tipped tweezers to grasp the tick as close to the skin’s surface as possible. Then pull upward with steady, even pressure. If the tick's mouth breaks off and remains in the skin, try to remove it with tweezers.

Once the tick is removed, clean the bite area and your hands with rubbing alcohol or soap and water.

You can dispose of a live tick by putting it in alcohol, placing it in a sealed bag or container, and wrapping it in tape, or simply flushing it down the toilet. The CDC no longer recommends saving ticks to be tested for Lyme. However, some healthcare providers in high-risk areas may still conduct testing.

When to See a Healthcare Provider

Prompt treatment for Lyme disease reduces the risk of lingering symptoms and complications. If you have been bitten by a tick, contact your healthcare provider for guidance.

Factors that may cause your provider to prescribe prophylactic antibiotics—that is, those given when there's just a potential for tick-borne illness—include:

• A high incidence of Lyme disease in the geographic region
• The tick was removed in the last 72 hours
• The tick’s body was engorged with blood and not flat

It is also possible to get bitten by a tick and not realize it. See your healthcare provider if you develop a bull's-eye rash with or without fever or other symptoms of Lyme disease.

If you’ve been diagnosed with Lyme disease but still experience symptoms after completing antibiotic treatment, talk to your healthcare provider. Additional treatment may be required.

Summary

Lyme disease is not fatal, and most people make a complete recovery after antibiotic treatment. The best outcomes follow an early diagnosis, but those who develop stage 2 or stage 3 Lyme disease will usually still be cured either by more aggressive antibiotics or with the passage of time.

Complications resulting from Lyme disease include PTLDS, which does not respond to treatment but often resolves on its own. Lyme carditis occurs in 1% of cases and may require additional medication or a temporary pacemaker, but most people recover completely.