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~80% of patients have reported not being aware of a tick bite3-6

Diagnosing Lyme disease can be challenging without reported exposure and an often unclear clinical presentation.

For example, nymphal ticks are extremely small and their bites are often painless. Many people who have been bitten are not aware. Even those who perform “tick checks“ can miss an infected tick.7

Images illustrate relative scale of tick across life stages; anatomical features are not depicted
in full.

Up to 30% of patients are not being diagnosed until a later stage of the disease2

Varying skin rash presentation is another factor that can result in delayed diagnosis

  1. Erythema migrans (EM) rashes don’t always look the same, and are not always present.8
  2. Up to 30% do not exhibit a rash.1
  3. Less than 1 in 5 patients present with a bullseye rash.9
  4. On darker skin, the rash may be hard to see.1

Images of erythema migrans rash.

Localized Disease

Disseminated Disease

Tab Number 3

Tab Number 4

Tab Number 5

Untreated Lyme disease can manifest in a wide range of symptoms that present differently from patient to patient. Some patients may present disseminated disease symptoms without any recognized localized disease symptoms.1,9

Localized disease symptoms can be common and non-specific

In addition to EM, other early symptoms of Lyme disease may appear within days or weeks after a bite from an infected tick. These symptoms can mimic those from common viral illnesses and can easily be misinterpreted by patients.1

Early-stage signs and symptoms can include1:

EM (varying in appearance)

Fever, headache, fatigue, and chills

Muscle and joint aches

Untreated Lyme disease can manifest in a wide range of symptoms that present differently from patient to patient. Some patients may present disseminated disease symptoms without any recognized localized disease symptoms.1,9

Disseminated disease symptoms can be severe and impact a patient’s quality of life

Symptoms of early disseminated Lyme disease may not appear for weeks to months after a bite from an infected tick and can include1,10:

Additional EM rashes on other areas of the body

Neurological abnormalities, including facial palsy and nerve pain

Heart conditions such as myocarditis, pericarditis, atrioventricular nodal block, arrhythmias, and palpitations

Symptoms of late disseminated Lyme disease may not appear for months to years after a bite from an infected tick and can include1,11:

Arthritis, particularly the knee and other large joints

Ocular symptoms occur more rarely and can include uveitis, cranial nerve palsies, and optic neuritis

Between 5%-10% of patients diagnosed and treated for Lyme disease experience persistent, long-term symptoms, known as post-treatment Lyme disease syndrome (PTLDS). Patients with PTLDS report a strong negative impact on their quality of life, psychological well being, and greater financial and economic burden.12

 TitleEarly identification and diagnosis is critical.Don’t wait for your patients to be bitten. Talk to them about the risk of Lyme disease, and how to identify the symptoms, today.
Rethink how you're discussing risk with your patients 〉
LoadingReferences:1. Signs and symptoms of untreated Lyme disease. Centers for Disease Control and Prevention. Published May 15, 2025. Accessed March 12, 2026. https://www.cdc.gov/lyme/signs-symptoms/index.html 2. Hirsch AG, Poulsen MN, Nordberg C, et al. Risk factors and outcomes of treatment delays in Lyme disease: a population-based retrospective cohort study. Front Med (Lausanne). 2020;7:560018. Published November 26, 2020. 3. Eisen L, Eisen RJ. Critical evaluation of the linkage between tick-based risk measures and the occurrence of Lyme disease cases. J Med Entomol. 2016;53(5):1050-1062. 4. Thompson A, Mannix R, Bachur R. Acute pediatric monoarticular arthritis: distinguishing lyme arthritis from other etiologies. Pediatrics. 2009;123(3):959-965. 5. Nigrovic LE, Neville DN, Balamuth F, et al. A minority of children diagnosed with Lyme disease recall a preceding tick bite. Ticks Tick Borne Dis. 2019;10(3):694-696. 6. Orloski KA, Campbell GL, Genese CA, et al. Emergence of Lyme disease in Hunterdon County, New Jersey, 1993: a case-control study of risk factors and evaluation of reporting patterns. Am J Epidemiol. 1998;147(4):391-397. 7. How Lyme disease spreads. Centers for Disease Control and Prevention. Published September 24, 2024. Accessed March 11, 2026. https://www.cdc.gov/lyme/causes/index.html 8. Lyme disease rashes. Centers for Disease Control and Prevention. Published May 15, 2024. Accessed March 17, 2026. https://www.cdc.gov/lyme/signs-symptoms/lyme-disease-rashes.html 9. Tibbles CD, Edlow JA. Does this patient have erythema migrans? JAMA. 2007;297(23):2617-2627. 10. Gazendam N, Yeung C, Farina JM, Saldarriaga C, Mendoza I, Baranchuk A. Lyme & heart. In: Saldarriaga C, Baranchuk A., eds. Neglected Tropical Diseases and other Infectious Diseases affecting the Heart. Elsevier Inc; 2022: 61-71. 11. Trevisan G, Bonin S, Ruscio M. A practical approach to the diagnosis of Lyme borreliosis: from clinical heterogeneity to laboratory methods. Front Med (Lausanne). 2020;7:265. Published July 23, 2020. 12. Kullberg BJ, Vrijmoeth HD, van de Schoor F, Hovius JW. Lyme borreliosis: diagnosis and management. BMJ. 2020;369:m1041. Published May 26, 2020. doi:10.1136/bmj.m1041 13. Cameron DJ, Johnson LB, Maloney EL. Evidence assessments and guideline recommendations in Lyme disease: the clinical management of known tick bites, erythema migrans rashes and persistent disease. Expert Rev Anti Infect Ther. 2014;12(9):1103-1135. Lyme disease risk accumulates from routine, everyday exposures your patients may overlook.8,9,14 Higher tick exposure calls for updated protection guidance

As patients face greater risk of encountering ticks during everyday activities, it’s important to reassess protective measures.13

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