Shaping better health
REMEDY : BNSSG referral pathways

Lyme Disease

Checked: 19-03-2018 by Rob.Adams Next Review: 19-03-2019



Lyme disease is transmitted by the bite of an infected tick and most commonly appears as a rash around the bite area (erythema migrans). In the UK, about a third of cases do not have a rash and may present with fever, headache or neurological symptoms.

Diagnosis and initial treatment

For more information about diagnosis and treatment then please see the PHE website - quick summary below:

1. Patients seen by a general practitioner with an erythema migrans rash at the time of consultation should be treated with antibiotics.

2. Patients without a rash but with symptoms suggestive of Lyme disease and a credible risk of tick exposure should have serum taken and sent to an NHS laboratory for Lyme disease antibody testing (Borrelia burgdorferi). The decision to treat on clinical suspicion should be based on exposure history and the presenting symptoms. Note that up to a third of cases of Lyme disease do NOT have a classical rash, if any at all, and absence of rash or any recollection of a tick bite does not exclude the diagnosis. The most common early symptoms in adults are flu-like symptoms of aching, fever, headache, fatigue, sweating, joint pain, light and sound sensitivity, abnormal skin sensations (tingling, numbness, itching), stiff neck. Facial palsy, headache and fever in tick season (April to October) has been shown to predict Lyme disease in children.

3. Patients with tests that are positive from an NHS laboratory should be treated if presenting symptoms and signs are compatible with active Lyme disease.

4. If an initial serological test is negative, but symptoms persist it is worth sending a repeat sample 3-4 weeks after the initial test as the antibody response to Lyme can take time to develop and fluctuates in early disease. Patients with positive results who have not already been treated should be treated with antibiotics.

Advice can be obtained from the Rare and Imported Pathogens Laboratory (RIPL) staff in working hours on 01980 612348.

A patient leaflet 'Tick bite risks and prevention of Lyme disease' can be downloaded.



The NICE Lyme Disease guidelines are summarised in CKS (July 2018)  and include advice on management of patients with persisting symptoms after treatment for Lyme disease and when to consider referral.