Lyme Disease - Office Visit

This is an office visit for the evaluation and treatment of a bacterial infection transmitted by a tick bite.

This is an office visit for the evaluation and treatment of a bacterial infection transmitted by a tick bite.

Lyme disease is an infection caused by bacteria called Borrelia burgdorferi (B. burgdorferi).

  • The bacterium is found in small rodents and other mammals, such as white-tailed deer.
  • Ticks that feed on these animals may become infected. They can then transmit the bacteria to other animals and people.
  • The only ticks that have been found to carry the bacteria are the small deer tick and the western black-legged tick. These ticks are about the size of a pinhead or poppy seed.
  • The small size of these ticks means that many people are not aware they have been bitten.
  • The more common wood tick is four times larger than the deer tick. Wood ticks do not transmit Lyme disease.

Lyme disease is:

  • Common from April to October, but the number of cases peaks in June and July.
  • Most common in children younger than age 15 and adults age 30 and older.
  • More common in some parts of the USA (e.g., the Northeast and Upper Midwest).
  • Able to be contracted more than once.

Lyme disease is not spread from person to person. It is also not spread through contact with an infected animal.

  • Transmission of Lyme disease occurs when infected ticks attach to people. This frequently occurs when someone brushes against leaves and brush where ticks are found.
  • Pets can also carry ticks into the home and can then attach to humans.

To get Lyme disease, it is believed that an infected tick must be attached to a host for twenty-four to forty-eight hours.

  • Symptoms usually begin in seven to fourteen days. However, the incubation period can range from three to thirty-two days.
  • Ticks can also spread other diseases. A single tick bite can transmit more than one disease.

The symptoms of Lyme disease typically develop in three stages. During the first stage there may not be any symptoms or symptoms may come and go. Some of the symptoms include:

  • A circular “bull's-eye” rash at the site of the tick bite
  • Headache
  • Fever
  • Fatigue
  • Muscle and joint pain
  • Swollen lymph nodes

If untreated, the second stage begins three to five weeks after exposure. During this stage, more generalized symptoms can develop. These symptoms can include:

  • A rash that is similar to the original rash, but develops in other areas of the body
  • Fatigue
  • Fever
  • Chills
  • Headache
  • Facial palsy (loss of ability to move one side of the face)
  • Meningitis (inflammation of the membranes surrounding the brain and spinal cord)
  • Muscle and joint pain that can move from one place to another
  • Inflammation of parts of the eye
  • Rarely, inflammation of the heart muscle or slowing of heart rate

The third stage can develop months or years later. The symptoms associated with this stage can develop even if there were no earlier symptoms. It is often characterized by:

  • Intermittent joint pain and swelling, usually in the knees and other large joints
  • Heart problems
  • Central nervous system problems that can include memory loss, personality changes, fatigue and sleep disturbances

Lyme disease can be difficult to diagnose because it can mimic other conditions and there is no uniformly reliable test to confirm the diagnosis. Therefore, diagnosis is based on:

  • Symptoms
  • A history of a tick bite
  • Exposure to tick-infested areas
  • Blood tests that check for antibodies (i.e., enzyme-linked immunosorbent assay [ELISA], immunofluorescence assay [IFA] and Western blot [WB] test)

Unfortunately, blood tests are often not reliable until later in the disease.

  • Many people who have Lyme disease test negative.
  • People can test positive when they do not have the disease.
  • Because of the above, healthcare providers will often begin treatment for Lyme disease based on symptoms and areas of the country a person has been to.

At this time, the Centers for Disease Control and Prevention (CDC) recommend two step testing. The first step is done using the ELISA, or rarely the IFA test.

  • If the results are positive or indeterminate, then the WB test is done.
  • The diagnosis of Lyme disease is more certain if the ELISA or IFA and the WB are positive.

The ticks that transmit Lyme disease are tiny, so you may not know you have been bitten. Therefore, contact your healthcare provider if you have symptoms of Lyme disease, regardless of whether or not you have been bitten by a tick. Your healthcare provider will perform a physical examination and ask questions about your medical history. If there is a high suspicion of Lyme disease, laboratory blood tests may be recommended.

  • Tick bites by themselves do not require antibiotic treatment.
  • The decision to treat with antibiotics is based on the circumstances and risks the tick bite presents.

If you have symptoms of Lyme disease, treatment may be started before testing has been completed if you know you have been bitten by a tick OR you or your pet have been in tick-infested areas and you could have been bitten.

  • In areas with a high incidence of Lyme disease, your healthcare provider may treat a suspected deer tick bite with a single dose of an antibiotic.
  • Close follow-up will be needed to watch for any new symptoms that suggest Lyme disease. If that happens, additional antibiotic treatment may be needed.
  • Antibiotic treatment for diagnosed Lyme disease is usually given by mouth for twenty-one days.
  • In certain situations, such as when certain heart or neurological problems occur, treatment may be given intravenously or injected into a muscle. In those cases, treatment can last as long as twenty-eight days. There is no evidence that longer treatment results in better outcomes.

If you have been bitten by a tick and concerns about Lyme disease, contact your healthcare provider.

  • Write down the details of your tick bite. If you saved the tick, put it in a closed container or zip lock bag and bring it with you to your appointment.
  • Write down any questions, symptoms or concerns you want to talk about.
  • Bring a copy of your medical history (past illnesses, surgeries, and hospitalizations). It is particularly important to know what your risk for heart disease is and to discuss a plan to decrease that risk.
  • Make a list of your medications (including over-the-counter).
  • If your healthcare provider wants you to take a medication, ask if an over-the-counter product is right for you.
  • If your healthcare provider prescribes a medication for you, ask for a generic version. If your doctor thinks that a generic version is not right for you, ask for a medication on the lowest available tier of your Prescription Drug List (PDL).

Here are some questions to ask your healthcare provider.

  • What are some of the complications of a tick bite? Am I at high risk for complications?
  • Do you think I have Lyme disease?
  • What tests are you recommending? What is the reason for those tests? Will the test results change my treatment plan?
  • What treatment, if any, are you recommending? What options are available?
  • If medication is recommended, how long will I need to take it? What are the possible side effects?
  • How long will it take my symptoms to improve?
  • What are my follow-up plans and what symptoms should I report before my next appointment?

After your appointment, you should understand your treatment plan, any possible alternatives, and what medications are recommended (including possible side effects).


Also known as:

Tick Bite
Lyme Disease - Office Visit
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