Lyme Disease Symptoms: Why They're Often Missed and What to Do Next

Lyme disease symptoms can be confusing. They often look like the flu, stress, or other common illnesses. Because of this, many people delay care or don't realize they've been infected at all.

Lyme disease is caused by bacteria (Borrelia burgdorferi in the U.S.) spread through the bite of infected blacklegged ticks. Early diagnosis and treatment matter. When caught early, Lyme disease is usually very treatable. When missed, symptoms can last longer and become more complex.

Below is a clear, practical guide to recognizing Lyme disease symptoms, understanding why they're often overlooked, and knowing what medical steps to take next.

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Early Lyme Disease Symptoms (Days to Weeks After a Tick Bite)

The first stage of Lyme disease often feels like a mild viral illness. Many people don't remember being bitten by a tick. Ticks are small, and their bites are usually painless.

Common early Lyme disease symptoms:

• Fever
• Chills
• Fatigue
• Headache
• Muscle and joint aches
• Swollen lymph nodes

The hallmark rash: Erythema migrans (EM)

One of the most recognizable Lyme disease symptoms is a spreading skin rash at the site of the tick bite.

• Often starts as a small red area
• Expands over days
• May form a "bull's-eye" appearance
• Usually not painful or itchy
• Warm to the touch

Not everyone develops the classic bull's-eye rash. Some rashes are solid red or uneven in shape. In people with darker skin tones, the rash may look like a bruise or darker patch and be harder to detect.

If you develop a spreading rash after possible tick exposure, doctors often diagnose Lyme disease based on the rash alone — blood tests may not yet be positive in early infection.

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Why Lyme Disease Symptoms Are Often Missed

There are several reasons why Lyme disease symptoms are overlooked:

1. Symptoms mimic common illnesses

Early Lyme disease can feel like:

• The flu
• COVID-19
• A viral infection
• Stress or exhaustion

Without a known tick bite or rash, Lyme may not be suspected.

2. Many people don't see the tick

Ticks can be:

• The size of a poppy seed (nymph stage)
• Attached in hard-to-see areas (scalp, groin, behind knees)
• Attached for 24–48 hours before transmission occurs

3. The rash is not always classic

• Not everyone gets a bull's-eye pattern
• Rash may be mistaken for a spider bite
• Rash may be hidden under hair or clothing

4. Symptoms can come and go

Fatigue, joint pain, and brain fog may fluctuate. People may think they're just "run down."

5. Testing is limited early on

Blood tests detect antibodies, which can take weeks to develop. Early testing may be negative even if infection is present.

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Later Lyme Disease Symptoms (Weeks to Months Later)

If untreated, Lyme disease can spread to other parts of the body.

Common later-stage Lyme disease symptoms:

• Severe headaches and neck stiffness
• Additional rashes on other parts of the body
• Joint pain and swelling, especially in the knees
• Facial drooping (Bell's palsy)
• Irregular heartbeat (Lyme carditis)
• Dizziness or shortness of breath
• Numbness or tingling in hands or feet
• Memory problems or difficulty concentrating

Joint swelling may come and go but can become persistent. Neurological symptoms, such as brain fog or facial weakness, should never be ignored.

In rare cases, heart involvement can cause:

• Chest pain
• Palpitations
• Fainting

These require urgent medical attention.

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Chronic Symptoms and Post-Treatment Lyme Disease

Some people continue to have symptoms even after completing appropriate antibiotics. This is sometimes referred to as Post-Treatment Lyme Disease Syndrome (PTLDS).

Symptoms may include:

• Ongoing fatigue
• Joint or muscle aches
• Difficulty concentrating
• Sleep disturbances

The cause is not fully understood. However, long-term antibiotic use beyond recommended guidelines has not been shown to provide additional benefit and can carry risks. Ongoing symptoms should be evaluated by a healthcare professional to rule out other conditions.

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When Abdominal Symptoms Occur

Lyme disease is not primarily a gastrointestinal illness. However, some people experience:

• Nausea
• Loss of appetite
• Abdominal discomfort

If you're experiencing stomach issues alongside other symptoms and want to explore what might be causing your Abdominal Discomfort, a free online symptom checker can help you identify possible causes before speaking with your doctor.

Digestive symptoms, especially if severe or persistent, should be evaluated by a doctor to rule out other medical conditions.

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How Lyme Disease Is Diagnosed

Diagnosis depends on timing and symptoms.

Early stage (with rash):

• Diagnosis is usually clinical (based on appearance of rash and history of tick exposure)
• Blood tests may not yet be accurate

Later stages:

Doctors typically use two-step blood testing:

1. ELISA (enzyme immunoassay)
2. Western blot (if ELISA is positive or equivocal)

Testing too early can produce false negatives. If suspicion is high, your doctor may recommend repeat testing later.

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Medical Next Steps If You Suspect Lyme Disease

If you think you may have Lyme disease symptoms:

1. Don't ignore a spreading rash

Seek medical care promptly. Early antibiotics are highly effective.

2. Document your symptoms

Write down:

• When symptoms started
• Possible tick exposure
• Travel history
• Any rash (take photos)

3. See a healthcare professional

Primary care doctors, urgent care providers, or infectious disease specialists can evaluate you.

4. Antibiotic treatment

When diagnosed early, Lyme disease is usually treated with:

• Doxycycline
• Amoxicillin
• Cefuroxime

Treatment length is typically 10–21 days, depending on the stage.

5. Seek urgent care if you experience:

• Chest pain
• Fainting
• Shortness of breath
• Severe headache
• Facial drooping
• Confusion

These may signal serious complications and should be evaluated immediately.

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Prevention: Reducing Your Risk

While treatment is effective, prevention is always better.

Protect yourself by:

• Wearing long sleeves and pants in wooded areas
• Using EPA-registered insect repellent
• Performing full-body tick checks after outdoor activity
• Showering within two hours of being outdoors
• Promptly removing ticks with fine-tipped tweezers

Ticks usually need to be attached for 24–48 hours to transmit Lyme bacteria, so early removal reduces risk.

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The Bottom Line on Lyme Disease Symptoms

Lyme disease symptoms can be subtle, especially in the early stage. Fatigue, mild fever, and body aches are easy to dismiss. The classic rash does not always look like a textbook image.

The good news is this:
When diagnosed early, Lyme disease is very treatable. Most people recover fully with timely antibiotics.

The key is awareness.

If you notice:

• A spreading rash
• Flu-like symptoms after tick exposure
• Unexplained joint swelling
• Facial drooping or heart symptoms

You should speak to a doctor promptly. Some complications of Lyme disease can become serious if left untreated.

Trust your instincts. If something feels unusual or persistent, seek medical advice. Early evaluation is far better than delayed treatment.

And if you are unsure whether your symptoms fit Lyme disease or another condition, consider starting with a structured symptom review — then follow up with a qualified healthcare professional.

Your health is too important to guess.