Ask the expert: Your top questions about Lyme disease, answered

Lyme disease is one of the most common tick-borne illnesses in the United States, affecting thousands of people each year. Caused by the bacterium Borrelia burgdorferi, Lyme disease can lead to serious health complications if not detected and treated early.
To help you better understand Lyme disease symptoms, diagnosis and treatment, we spoke with Laura Gillim, PhD, medical science liaison and discipline director of infectious disease immunology at Labcorp. In this blog, she answers common questions about Lyme disease and discusses how to work with your healthcare provider to recognize the signs and manage it effectively.

How is Lyme disease transmitted?

Lyme disease is transmitted through the bite of infected blacklegged ticks (also known as deer ticks). These ticks are commonly found in wooded and grassy areas, especially in the Northeastern, Mid-Atlantic and Upper Midwest regions of the U.S. The risk of Lyme disease increases in spring and summer when ticks are most active.

“While not every tick bite leads to Lyme disease, prompt removal of ticks and monitoring for symptoms is essential,” says Dr. Gillim. In areas where Lyme disease is common, ticks may also carry other infections like human anaplasmosis or babesiosis.

What are common symptoms of Lyme disease?

Symptoms of Lyme disease can vary depending on the stage of infection:
 

Can I get Lyme disease if I don’t see a tick or a rash?

Yes. Many people with Lyme disease don’t recall being bitten by a tick, and about 30% of infected individuals never develop the classic Lyme disease rash.

“Tick bites can be painless and easy to miss, especially in hard-to-see areas like the scalp or behind the knees,” notes Dr. Gillim.

If you experience symptoms of Lyme disease after spending time outdoors, especially in tick-prone areas, talk to your healthcare provider—even if you didn’t see a tick or rash.

How is Lyme disease diagnosed?

Diagnosis is based on symptoms, exposure history and sometimes lab tests, explains Dr. Gillim. If you have the classic bullseye rash and live in or recently visited an area where Lyme disease is common, your provider may diagnose Lyme disease without testing.

If lab testing is needed, the CDC recommends a two-step process:

1. Initial blood test to detect Lyme antibodies
2. Confirmatory test if the first result is positive or unclear

Keep in mind:

• Antibodies may take 2–6 weeks to develop
• Early testing can result in false negatives
• False positives may happen due to other infections (e.g., syphilis, Epstein-Barr virus) or autoimmune diseases
• Antibodies can persist for months or years, making it hard to distinguish past from current infection

What is the treatment for Lyme disease?

Lyme disease is typically treated with a 2–4-week course of oral antibiotics. Most people recover fully, especially when treatment begins early. However, some individuals may experience lingering symptoms such as fatigue, joint pain or cognitive difficulties—a condition known as post-treatment Lyme disease syndrome.

If you’re wondering whether Lyme disease can go away on its own, the answer is no, says Dr. Gillim. Untreated Lyme disease can lead to serious complications, so early medical intervention is key.

What are the long-term symptoms of untreated Lyme disease?

If left untreated, Lyme disease can affect multiple systems in the body. Long-term symptoms may include:

• Severe headaches and neck stiffness
• Facial palsy (drooping on one or both sides of the face)
• Arthritis with joint pain and swelling
• Heart palpitations or Lyme carditis
• Nerve pain and numbness
• Inflammation of the brain and spinal cord
• Dizziness and shortness of breath

“These complications highlight what Lyme disease can do to a person when not properly managed,” explains Dr. Gillim.