Lyme disease can look different depending on how long the infection has been present. Here’s what to know about how signs and symptoms can change over time.
When people picture Lyme disease, they may think of a tick bite followed by a classic bullseye rash. But Lyme disease doesn’t always follow one simple pattern.
Symptoms can change over time, and not everyone experiences Lyme disease in exactly the same way. Untreated Lyme disease can cause a range of symptoms depending on the stage of infection.
Understanding the different stages of Lyme disease can help you know what changes to pay attention to and what information may be useful to share with a healthcare provider.
What Are the Stages of Lyme Disease?
Lyme disease is a bacterial infection spread through the bite of infected blacklegged ticks. In the United States, it is primarily caused by the bacterium Borrelia burgdorferi.
Lyme disease is commonly described in three stages:
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Early localized Lyme disease
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Early disseminated Lyme disease
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Late Lyme disease
These stages describe how the infection and its symptoms can change as time passes. Cleveland Clinic places early localized disease at about one to 28 days after a tick bite, early disseminated disease at roughly three to 12 weeks, and late Lyme disease at months after the initial infection. These are general timelines, not a schedule that every case will follow.
A peer-reviewed review of Lyme disease also describes three clinical stages and notes that manifestations can overlap.
Stage 1: Early Localized Lyme Disease
Early localized Lyme disease happens near the beginning of the infection.
The CDC says early signs and symptoms can appear three to 30 days after a tick bite. They can include fever, chills, headache, fatigue, muscle and joint aches, and swollen lymph nodes.
And importantly, these symptoms can occur even when there is no rash.
That can make early Lyme disease harder to recognize. California’s Department of Public Health notes that early Lyme disease can begin with symptoms that may resemble the flu.
What Does an Early Lyme Disease Rash Look Like?
An erythema migrans (EM) rash is one of the best-known signs of early Lyme disease.
According to the CDC, an EM rash typically begins at the site of a tick bite after a delay of three to 30 days. It gradually expands over several days and can grow quite large.
But here’s an important part: it doesn’t have to look like a bullseye.
The rash can vary widely in appearance and does not always have the classic target shape. It may appear as an expanding rash without central clearing or have a red-blue appearance. The CDC also provides examples of erythema migrans on both dark and light skin.
And not everyone with Lyme disease develops — or notices — a rash. The CDC estimates that an EM rash occurs in approximately 70% to 80% of infected people.
So while the bullseye rash is useful to know about, it shouldn’t be treated as the only possible sign of Lyme disease.
Stage 2: Early Disseminated Lyme Disease
If the infection spreads beyond the original area of the tick bite, Lyme disease can enter what is called the early disseminated stage.
In plain language, “disseminated” means spread.
At this stage, Lyme disease can begin affecting areas beyond the skin. Possible signs and symptoms can include additional EM rashes elsewhere on the body, severe headaches or neck stiffness, facial palsy, nerve pain and heart-related symptoms.
Some people may experience facial palsy, which causes weakness or drooping on one or both sides of the face. Others may experience numbness, tingling or shooting nerve pain.
The American Lyme Disease Foundation also describes early disseminated Lyme disease as occurring when the bacteria spread from the initial site to other parts of the body.
This is one reason two cases of Lyme disease may not look identical. The symptoms someone experiences can depend in part on which areas of the body are affected.
Stage 3: Late Lyme Disease
Late Lyme disease can develop months after the initial infection, particularly when an infection has gone untreated.
One of the best-known later manifestations of Lyme disease is Lyme arthritis.
Lyme arthritis can cause noticeable swelling and pain in one or a few joints. The CDC notes that the knees and other large joints are particularly likely to be affected.
The CDC also lists arthritis with severe joint pain and swelling among the later signs and symptoms of untreated Lyme disease.
Later manifestations can also involve the nervous system. Cleveland Clinic lists nerve-related and cognitive symptoms among possible manifestations of untreated late Lyme disease, while the New York State Department of Health notes that Lyme disease can cause more serious problems involving the nervous system, heart and joints.
The peer-reviewed review you provided also describes Lyme disease as a multisystem disease with possible musculoskeletal, neurological and other manifestations.
The important takeaway isn’t that everyone with Lyme disease will eventually develop these problems. They won’t. Rather, Lyme disease can look different as time passes, which is why recognizing possible symptoms and discussing changes with a healthcare professional matters.
Does Everyone With Lyme Disease Go Through Every Stage?
No.
Although Lyme disease is often explained using three stages, those categories describe patterns of disease. They aren’t three boxes every person with Lyme disease will necessarily check.
The peer-reviewed review of Lyme disease notes that the manifestations of the three clinical stages can overlap.
Someone may experience an EM rash and flu-like symptoms early on. Someone else may never notice a rash. Another person may first seek medical care after developing a symptom associated with disseminated disease.
Even the timing can vary. The CDC groups later signs and symptoms as potentially occurring days to months after a tick bite.
That’s why knowing the range of possible symptoms can be more useful than waiting for Lyme disease to look exactly like a textbook example.
Why Does Catching Lyme Disease Early Matter?
Recognizing possible Lyme disease early matters because untreated infection can spread to other parts of the body.
The CDC states that patients who receive appropriate antibiotic treatment in the early stages of Lyme disease usually recover rapidly and completely.
California’s Department of Public Health also notes that early symptoms may go away even when an untreated person remains infected, with more serious health problems potentially appearing later.
This doesn’t mean every headache, sore muscle or rash after spending time outside is Lyme disease. Those symptoms can have many causes.
It does mean that a known tick bite, possible tick exposure, a new rash or changes in how you feel can be useful information to keep track of and discuss with a healthcare provider.
What Should You Do After a Tick Bite?
Finding a tick can be unsettling. But the first step is knowing what to do next.
If a tick is attached, remove it promptly and correctly. The CDC recommends using clean, fine-tipped tweezers to grasp the tick as close to the skin’s surface as possible and pulling upward with steady, even pressure.
After removing the tick, it can be helpful to keep track of information such as:
- When you found the tick
- Where it was attached
- Where you may have encountered it
- Any rash or skin changes
- Any changes in how you feel afterward
If you want a step-by-step guide, we break down what to do next in I Found a Tick. Now What?
If you develop symptoms after a tick bite or have concerns about your individual situation, talk with a healthcare provider. Details about the bite, possible exposure and changes you’ve noticed can help make that conversation more informative.
Knowing What to Look For
Learning about the stages of Lyme disease isn’t about assuming every rash, headache or sore joint after a day outside means Lyme disease.
It’s about knowing that Lyme disease can change over time.
Early illness may include a rash or flu-like symptoms. Disseminated disease can involve areas such as the nervous system or heart. Later manifestations can include problems such as Lyme arthritis. And not everyone will experience the same symptoms, in the same order, on the same timeline.
Knowing what to look for can help you keep track of meaningful changes and have a more informed conversation with your healthcare provider.
Because when it comes to ticks, the goal isn’t to be scared of the outdoors. It’s to know what to do when a tick comes home with you.
Frequently Asked Questions
What are the three stages of Lyme disease?
Lyme disease is commonly described as early localized, early disseminated and late Lyme disease. The stages describe how Lyme disease and its possible manifestations can change over time, although individual experiences and timelines vary.
How soon do Lyme disease symptoms start?
The CDC says early signs and symptoms can appear three to 30 days after a tick bite. Possible early symptoms include fever, chills, headache, fatigue, muscle and joint aches, swollen lymph nodes and an EM rash.
Does everyone with Lyme disease get a bullseye rash?
No. The CDC estimates that an EM rash occurs in approximately 70% to 80% of infected people, and it doesn’t always have the classic bullseye appearance. The shape and appearance of the rash can vary.
Can Lyme disease spread to other parts of the body?
Yes. In disseminated Lyme disease, the infection has moved beyond the initial site. Depending on the manifestation, Lyme disease can affect areas including the nervous system, heart and joints.
Can you have Lyme disease without knowing you were bitten by a tick?
Yes. A person may not realize a tick was attached. Ticks can be very small, and a person may develop symptoms without remembering a bite.
When should I talk to a doctor after a tick bite?
If you develop symptoms after a tick bite or have concerns about a possible exposure, contact a healthcare provider. Information about when and where the possible exposure occurred, whether you found a tick, and any symptoms or skin changes you’ve noticed can be useful to share.
Sources and Further Reading
- CDC: Signs and Symptoms of Untreated Lyme Disease
- CDC: Lyme Arthritis
- CDC: Lyme Carditis
- Cleveland Clinic: Lyme Disease
- CDC: What to Do After a Tick Bite
- Peer-reviewed article: Lyme Disease: An Overview
This article is for general educational purposes and is not a substitute for medical advice.
