The symptoms of Lyme disease and why it's important to pay attention to them

• Lyme disease starts with a tiny tick bite that can be easy to miss, but if left untreated it can cause permanent joint pain and, in rare cases, death.
• The most common symptom is a rash that can range in size from a 1 inch in diameters to as many as 12 inches.
• You should also watch for symptoms like fever, fatigue, muscle pain, and loss of appetite.
• This article was medically reviewed by Tania Elliott, MD, who specializes in infectious diseases related to allergies and immunology for internal medicine at NYU Langone Health.

More than 30,000 cases of Lyme disease are reported each year. But, due to unreported cases, the number of people who actually contract the disease is likely far greater.

Since Lyme disease starts with a tiny tick bite, many people are unaware that they have been bitten and do not get the care they need. But left untreated, Lyme disease can cause serious issues like arthritis and heart problems.

In this article, we discuss the signs and symptoms of Lyme disease so you can recognize your condition and seek medical care immediately.

What is Lyme disease?

Lyme disease is an infection that develops after you've been bitten by a black-legged deer tick that carries a certain kind of bacteria. There are two kinds of bacteria that cause Lyme disease in the United States: Borrelia burgdorferi, and rarely, Borrelia mayonil.

The disease is more common in the northeastern states, with recent increased activity in the Midwest, too. But some West Coast ticks also carry the bacteria.

Symptoms of Lyme disease

It can be easy to miss a tick bite. Deer ticks are very small, growing to be no larger than a sesame seed. So you might not notice them on your skin. Even if you do notice a tick bite, you might not connect the tick bite with a rash that you develop a week or two later. This rash sometimes develops at the site of the bite, but it can appear anywhere.

Known as erythema migrans, that rash is the telltale symptom of Lyme Disease and is usually the first symptom to appear. It's a red rash that tends to expand outward, often (but not always) forming a bullseye pattern. While not everyone infected with Lyme Disease gets this rash, the Centers for Disease Control and Prevention (CDC) estimates that 70-80 percent do.

This kind of rash can range in size from a few centimeters across to as many as 12 inches in diameter, and can last for several weeks. It might be warm to the touch, or it could be a little itchy. But the rash is usually not painful, says Jorge Benach, PhD, distinguished professor of microbiology at the Renaissance School of Medicine at Stony Brook University.

The rash can even disappear and reappear weeks later. In that case, you may develop more than one. Beyond the rash, other symptoms you might develop can include:

• Fever and chills
• Fatigue
• Stiff neck
• Headaches
• Muscle and joint pain
• Swollen lymph nodes
• Loss of appetite

In rare cases, Lyme disease may develop into other serious conditions, like carditis — which is inflammation caused by an infection of the heart, says Benach. Lyme carditis can make you feel light-headed, weak, feverish, and achy, and may also cause heart palpitations.

If you notice that a growing red rash or other symptoms, call a doctor immediately. You'll probably get a prescription for an antibiotic.

Get treated immediately

A course of oral antibiotics can usually knock the disease out in two to three weeks. Left untreated, however, the disease may eventually cause joint pain, neurological problems, and in rare cases, death.

Sheeja Francis, MD, practices rheumatology with Premier Medical Group in Orange County, New York, which has a high incidence of Lyme disease. As a result, she treats patients who've developed arthritis from Lyme disease — many of whom don't recall the original tick bite that started the problem.

"Due to the concern for Lyme disease, if there is a known tick bite, people in our area usually contact their primary care physician and are usually given a prophylactic course of antibiotics," said Francis. Those antibiotics should be able to help prevent the infection from taking root.

Most people who are diagnosed and treated with antibiotics will recover just fine. But it's also possible that you might suffer some longer-lasting effects even after you finish the antibiotics. For example, even though the antibiotics knocked out the bacteria, some damage to your joints or nerves has already occurred, which can lead to long term pain. Experts call this Post-Treatment Lyme Disease Syndrome.

Preventing Lyme disease

Anytime you're going to be spending time outdoors, especially in heavily forested areas, it's worth taking a few steps to reduce the chances of getting bitten by a tick.

• Use insect repellant with DEET, which can repel ticks
• Spray the insecticide permethrin on your clothes to repel the ticks, too
• Consider wearing light-colored long sleeves and long pants to cover more skin and make ticks more visible

"If you go outside, when you come home, check yourself," says Benach. "Check yourself in the parts that you can see and have somebody else check the parts that you can't." Some trouble spots you'll need help with may include behind the ears, the back, and behind the armpits.

The earlier you spot a tick, the sooner you can remove it. According to the CDC, you're much less likely to develop Lyme Disease if you can get that infected tick off your skin early, within 24 hours.

"The general consensus is that speed in removing the tick is certainly to your advantage," says Benach.

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