5 Signs of Lyme Disease You Really Shouldn’t Ignore

Julia Sullivan
·9 min read

Ed Reschke/Getty Images

There’s a lot to be wary of when you’re out exploring in nature—hungry bears, venomous snakes, sudden downpours, your two left feet. But even if you get home relatively unscathed, you’re not in the clear juuuuust yet. You might’ve unknowingly picked up—and are providing a meal for—a parasitic hitchhiker: Depending on where you are in the US, it could be either the black-legged deer tick or the western black-legged tick. Both of these bloodthirsty vampires can sometimes carry a type of bacteria called Borrelia burgdorferi. And when a tick sinks its fangs (well, it’s more of a razor-sharp feeding tube) into your flesh to drink, small amounts of its saliva (with those bacteria) can enter your body too. In some cases, this can cause Lyme disease, a syndrome with uncomfortable, gnarly, and sometimes debilitating symptoms that can affect the body in wide-ranging ways.

But there’s some good news: “Lyme disease is a very, very antibiotic-responsive condition. It has a bad reputation for being difficult to treat, but it’s never too late to treat it,” Anne Bass, MD, a rheumatologist at the Hospital for Special Surgery in New York City, tells SELF. To nip it in the bud, you have to have an inkling that something’s up, and, again, you’re more likely to get infected with Lyme if you are spending time outdoors under certain circumstances (more on that in a minute!). Here are five Lyme disease symptoms to watch out for, especially as the weather warms up.

1. You have a bull’s-eye-shaped rash (or something like it)—or you spot a tick latched onto your skin.

Finding a tick stuck in your skin doesn’t necessarily mean you’re infected. It typically needs to be attached to your body for at least 36 to 48 hours for the bacteria to transfer over to you, and removing it quickly, hopefully within 24 hours, can greatly reduce your chances of getting Lyme. (Here’s how to safely remove a tick.) If a Lyme-carrying tick is attached to you for long enough, the disease can progress in three phases, Cassandra Pierre, MD, MPH, an infectious disease physician at Boston Medical Center, tells SELF:

  • Stage 1: Known as localized Lyme because the bacteria haven’t spread throughout the body

  • Stage 2: Known as disseminated Lyme because the bacteria are spreading to the rest of the body

  • Stage 3: Known as late-disseminated Lyme because the bacteria have spread to the joints and nerves

During stage 1, you might develop a rash after the infected critter (ticks are arachnids, so they are more closely related to spiders than insects) bites you. Most of these are “nymphal” ticks—essentially babies—which are super tiny (about the size of a poppy seed) and like to latch onto skin in humid, hard-to-see places, like behind the ears or knees. Plus, as Dr. Pierre explains, you can’t always feel that it’s there, as “the bite usually isn’t painful. It can sometimes be a little itchy, and maybe a little warm to the touch, but surprisingly many of my patients do not feel much or even notice it’s there.” After that, Dr. Pierre explains, “you might see some initial redness, then after a few days to weeks, it starts to expand outward, which causes a bull’s-eye-shaped appearance.” She adds that it’s typically flat and not raised.

That said, the bullseye rash can look much more subtle on some people. It may not appear as vividly if you have dark skin, says Dr. Pierre. “Or, it could appear as if there’s hyperpigmentation.” Research shows that Black people are at a higher risk for Lyme disease misdiagnoses than people with lighter skin.

You might develop multiple rashes (even from a single bite) and some 20% of people don’t see any skin changes whatsoever, so it’s possible your first Lyme symptoms may be a little different. If the tick is engorged (meaning it's bloated because it’s been there several days feasting on your blood) or if you think it’s been there long enough, you should make a note of that and call a doctor if you’re concerned. (The CDC doesn’t typically recommend antibiotics for tick bites unless you have symptoms, but talk it over with your health care provider.)

2. It might feel like you’re coming down with the flu.

When your body responds to the bacteria, you may have a fever, headaches, chills, and muscle pain. The timeline can be a little wonky though, per Dr. Pierre. “The symptoms don’t happen in lockstep—it’s not like you get the rash and then two days later develop a fever. You might not get a rash, or it fades before you can even see it—then a week or two later you feel other symptoms.” (Note: These stage 1 symptoms can occur within 1 to 28 days following a tick bite, per the National Library of Medicine.)

Of course, there are a ton of other things that can cause these symptoms too, per Dr. Bass. So when you’re trying to figure out if it was due to a tick bite, you really have to take several things into consideration, including where you live in the country, what time of year it is, if you’ve spent time outdoors recently, and any other symptoms that are paired with your fever.

“The flu tends to come in the winter, roughly December through April, and people don’t typically get early Lyme disease at that time,” Dr. Bass points out. “Lyme disease also does not normally cause respiratory or gastrointestinal symptoms, so if you get a stuffy nose, sore throat, or even diarrhea or nausea, you’re probably dealing with a virus.” You’re more likely to encounter Lyme-infected ticks between April and October in the wortheast, northwest, or upper Midwest, particularly if you’re hanging out in habitats where ticks thrive, like wooded, brushy places with tall grass and lots of dead leaves on the ground.

3. You’re having heart issues, strange dizziness or weakness, or you’ve developed another condition.

After you’ve been infected for a few weeks or months (which is plausible if you didn’t see or notice a rash from the bite or shrugged off any early flu-like symptoms), the bacteria can travel through your bloodstream to other parts of your body (a.k.a. stage 2 of Lyme disease, which usually happens about 3 to 12 weeks after the bite). This includes the heart. It’s called “Lyme carditis,” and it can cause things like heart palpitations, chest pain, and dizziness.

The bacteria might also migrate to your brain and spinal cord, which can cause vertigo and difficulty with coordination, or even meningitis, says Dr. Bass. This is a serious inflammation of the membranes surrounding the brain and can result in headaches, neck stiffness, and fever. Bell’s palsy—an inflammation that affects the facial nerves—can also sometimes show up and cause your face to get weak or droop on one side. However, Dr. Bass reiterates that, even at this stage, you can still recover. “These [later symptoms] all typically respond very nicely to antibiotics.”

4. There’s major swelling in one or several joints.

It’s possible to get bit by an infected tick and have zero symptoms up until stage 3, Dr. Bass says. “If you haven’t been treated for several months, or even years, after the [initial] infection, the bacteria can often settle in a joint, most commonly the knee,” she says. However, Dr. Pierre notes that any big joint can be affected, including the hip and elbow. The swelling isn’t always painful, but it can be: Research shows that roughly 60% of untreated Lyme-related infections cause arthritis. You might also develop those neurological issues we mentioned that can happen with stage 2—Bell’s palsy, meningitis—but it’s important to remember that this is still treatable, Dr. Bass points out. You might just have to be on antibiotics a bit longer (or take a combo of them on a more rigorous regimen), she notes.

5. You fit the profile of someone who’s recently been bitten by an infected tick.

Okay—this one isn’t *necessarily* a medical symptom, but per Dr. Pierre, it’s really important. She says that a lot of people who struggle with chronic fatigue or pain (and once had Lyme disease several years ago) believe their issues are tied to that previous infection. That’s not always the case—and they’re sometimes unnecessarily put on rounds of antibiotics.

In some cases, it’s possible to develop something called “post-Lyme disease syndrome,” Dr. Pierre says, but doctors don’t know a ton about it yet. “Some people take a few weeks to months to completely heal [after being infected with Lyme]. There is a small proportion of people who have chronic fatigue, a general feeling of being unwell, or other symptoms that don’t respond to antibiotics, and we don’t know why that is,” she says. And Dr. Bass notes that it’s really, really tough to pin down why someone might be feeling crappy. “Many people have fatigue, it’s a very common complaint,” she says. “The list of possible explanations is very long.” That doesn’t mean the fatigue or other persistent symptoms aren’t real—you know your body best!—but identifying the source can sometimes be complicated, even for specialists.

Again, to really narrow things down, Dr. Pierre says it’s important to consider where you live and what time of year it is. So if you went hiking, camping, or even gardened for a few hours in a tick-heavy area in a peak month, and you feel like you’re coming down with the flu, Lyme disease is definitely something worth thinking about (and local doctors will also probably have this in mind). Either way, they should work with you to figure out whatever’s causing you grief—be it a bloodthirsty tick or something else—and put you on the fast track toward feeling better.

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Originally Appeared on SELF