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4 Misconceptions About Lyme Disease

Kelsey Tyler

The patch of poison ivy on my face itched like crazy as I led a gaggle of third-graders to the pool for swimming lessons. Poison ivy was virtually an occupational hazard, seeing as the three-leaved plants were abundant in the shallow woods where I regularly took my campers hiking. So when a red, spotted rash appeared on my hip a few days later, I figured it was just more poison ivy to cover in calamine lotion and resist scratching. But as the week went on, the spotted rash spread to my stomach and across my other hip.

With a growing portion of my torso covered in splotches, it seemed like time to see a doctor. At an urgent care clinic near the summer camp, a doctor prescribed a cream for some sort of fungus she said I picked up in the woods. She was partially right: My rash did come from the woods, but it wasn’t fungal. I had Lyme disease, courtesy of a tiny vampire tick that had latched onto my hip and bitten me without my knowing it.

I only ended up with the correct diagnosis because my mom tagged along at my appointment. Her own case of Lyme had gone undiagnosed for months, partially because her own oddly shaped rash looked nothing like the textbook “bullseye” Lyme rash. She insisted the doctor test my blood. Call it mother’s intuition. Or just pure luck. Regardless, her hunch was spot on.

“There is nothing else in the world that causes that rash; nothing else in the entire universe except the Lyme bacteria.”

That’s not always how things go after people contract Lyme. While about 30,000 cases of Lyme disease are reported annually, the actual number of people infected each year is projected to be around 300,000, according to the Centers for Disease Control and Prevention. In other words, the vast majority of Lyme remains undiagnosed.

Infections are also on the rise across the country. The prevalence of tick-borne illness more than doubled between 2004 and 2016 — from 22,000 to 48,000 cases, per the CDC. Lyme disease accounted for 82 percent of those cases. As Dr. Erica Lehman, a tick-borne disease medical specialist in Beverly Hills, California, puts it: “Lyme disease is the fastest growing epidemic in the world.”

Experts say insufficient knowledge about the disease is a factor in its stealthy spread. To effectively manage Lyme, it’s important to get the facts straight. Here are four common misconceptions about this tick-borne bacterial illness.

Misconception: If you contract Lyme, you’ll develop a bullseye rash.
The truth: There’s no guarantee of that particular rash showing up. And without the bullseye, other Lyme symptoms can be hard to piece together.

The CDC describes the classic bullseye rash as a “circular red rash with a central clearing that slowly expands.” Many people (doctors included) learn to recognize it as the signature mark of Lyme. 

“There is nothing else in the world that causes that rash,” Lehman said; “nothing else in the entire universe except the Lyme bacteria. If you do get the [bullseye] rash, you have it. You have been infected.”

On the other hand, fewer than half of Lyme patients develop the bullseye rash, according to the Global Lyme Alliance. It’s just one presentation of what’s technically called an erythema migrans rash. Many people, like me, develop non-bullseye erythema migrans rashes, and some people don’t get one at all. 

Lyme-related rashes (bullseye or not) are also temporary, lasting only a few days, and often show up in hard-to-see places. For me, the rash on my stomach was impossible to miss. But ticks tend to seek out moist, warm parts of the body, like the space behind the ear, the bend of the knee, the groin and the hairline. Someone could easily develop a rash they never notice. And if they don’t know they had a rash in the first place, they won’t report it to a doctor, potentially interfering with a timely, accurate diagnosis.

Aside from the bullseye rash, early Lyme symptoms are also symptoms of many other ailments. For instance, I assumed my knees were achy from playing with kids all day, and that my lymph nodes were swollen because I’d been battling a sore throat. Then there was the abnormal, unyielding exhaustion. It was a level of tiredness I’d never felt before and which no number of naps or extra-long nights of sleep could get rid of. They were all Lyme-related.

Other early Lyme symptoms include fever, chills and headaches. However, over time, someone infected with Lyme can develop a number of more serious symptoms, including facial palsy, inflammation of the brain and spinal cord, and short-term memory loss.

Misconception: Blood tests can resolve any uncertainty surrounding a Lyme diagnosis.
The truth: Lyme disease is complicated to diagnose and blood tests aren’t always reliable.

Even when someone who’s exhibiting multiple Lyme symptoms sees a doctor for help, a correct diagnosis can be hard to come by. Not all primary care physicians are knowledgeable about the disease. On top of that, the blood tests used to diagnose Lyme aren’t perfect.

The CDC recommends a two-tiered Lyme testing process that measures your antibody response to the infection but not the infection itself. “That means we have to rely on your body to recognize the infection and develop the antibodies,” said Daniel Cameron, a Lyme disease expert in Mount Kisco, New York.

“A tick is nature’s dirty needle.”

The first step is a screening test, the enzyme-linked immunosorbent assay (ELISA), which is supposed to be highly sensitive to Lyme antibodies. If ELISA comes back negative, no further testing is recommended. If the result is positive (or even inconclusive), a Western Blot test (of which there are two types) is performed to confirm a Lyme diagnosis.

But the two-tiered system isn’t a sure bet. By some estimates, it misses almost half of Lyme infections. False negative results are particularly likely during the first four to six weeks after Lyme is contracted, as some people are slower to mount an antibody response that’s strong enough to register on a blood test.

Misconception: One round of antibiotics always clears up a Lyme infection.
The truth: Antibiotics are the recommended first-line treatment for Lyme, but fully treating the disease can be a complicated process.

The National Institute of Allergy and Infectious Diseases says Lyme disease should clear up after a single course of an antibiotic such as doxycycline or amoxicillin. While a few weeks of meds did the trick for me, about 10 percent of Lyme patients continue to experience symptoms after taking antibiotics, an issue called post-Lyme disease syndrome. Symptoms of PLDS include fatigue, difficulty sleeping, arthralgia (pain where two or more bones meet), myalgia (muscle soreness and aching), memory impairment and headaches.

If a patient still exhibits symptoms after taking antibiotics, a handful of other factors might be at play, including possible coinfections or simply not taking a long enough course of antibiotics.

“It’s a very complex disease,” said Dorothy Leland, vice president and director of communications for, a national patient advocacy organization. “The biggest misconception is that two to four weeks of antibiotics will fix you,” she said. “There are some people that seems to work for, but there are a whole lot of people that it doesn’t.”

Misconception: People primarily get tick bites in wooded areas during the summer.
The truth: You can pick up Lyme all year round, all over the country.

Tick bites should absolutely be top of mind when you’re forest-bathing in July. But even when you’re trapped in the city and shorts weather is a distant memory, you should still be aware of Lyme symptoms.

In recent years, Lyme disease has shown up in geographic areas previously considered relatively safe from tick-borne disease. As Quest Diagnostics reported last year, people are now testing positive for Lyme in all 50 states. The majority of cases do still occur in New England and the mid-Atlantic region, with Maine, Vermont and Pennsylvania topping the list of most-infected states. However, Lyme is now also common in Wisconsin, Minnesota, Oregon and other states in the Great Lakes and Pacific coastal regions.  

“A tick,” said Lehman, “is nature’s dirty needle.”

Two species of ticks are known to carry Lyme, and you don’t need to wade into the woods to come into contact with either kind. The blacklegged tick, also commonly known as the deer tick, is mainly found in the eastern half of the country; while the western blacklegged tick is native to the West Coast.

These stealthy arachnids can also survive in freezing temperatures. Come winter, ticks hide in leaves or brush. Snowfall provides insulation, enabling dormant ticks to live through the season. Additionally, ticks can latch onto animal hosts, such as mice, moose, deer and domestic pets, which helps them both get through the winter and travel far and wide distances.

If you think there’s a chance you have a tick bite, don’t hold out for the bullseye. Check in with a doctor as soon as possible and keep track of any and all symptoms. 

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Show Comments (8)
  1. Donna Bishop

    Just got my second Lyme tick bite. This time I saw the bulls eye rash immediately. No doubt about it …Lyme disease. Hopefully the three weeks of doxycycline will kill the bacteria as I was quickly diagnosed. Last time I had a rash but it was not bulls eye. Also had one swollen knee. A classic symptom of Lyme ad it spreads into the synovial fluid. Luckily my doctor sent off the fluid from my knee and saw the bacteria. After many weeks of doxycycline not any better, I had a pic line installed and did 34 days of liquid antibiotics. Then I had a classic post Lyme problem… rheumatoid arthritis. Went to a another specialist and did about a year of methotrexate. All the swelling around my joints went away. So this time I immediately got the doxycycline. I’m not taking any chances 😝

  2. Isabel

    Thanks for sharing, Donna, and hope the doxycycline works for you. I’m being tested for Lymes and waiting for blood test results. I’m hoping the result won’t be Lymes though as I was bitten at the beginning of June (by something) and have been watching the rash spread right across my stomach in the shape more resembling the outline of a rugby ball with the bite being in the centre. The bite was incredibly painful after initial itchiness and at times had to hold my clothing away from it as it hurt so much. The chemist prescribed hydrocortisone cream which I’ve been using twice daily and has lessened the colour of the rash but it still has a brighter edge to it. This has coincided with being seen at the hospital for a possible rheumatoid arthritis/lupus diagnosis for which I have been on Hydroxychloriquine twice daily. Yesterday I was told to stop the meds for more blood tests.

  3. Stacie

    Good afternoon. I found a tick on me about 16 hours after being in the forest. I tweezed it off but found a bulls eye rash on me the following day which was two days from the forest visit. I started doxycycline later that day.

    What else do I need to do to ensure I don’t have a challenging and long journey ahead of me? What else should I take or do?

    Do you think catching it soon enough within two days is enough to wipe out the infection without issues?

    Please advise… Thank you!

  4. Eleni

    Can Lyme disease spread from pregnant mom to fetus?

  5. Chris

    We just had a warm 72 degree day 1/12 (Sunday) here in MA. I found 2 ticks on me Tuesday night! I’m on Doxy for prevention as one of my tick tested for Lyme, Borrelia miyamotoi, and Anaplasma phagocytophilum ugh! Lost the second one somehow. I had no idea they come out in the winter!

  6. Nunya

    Lyme disease is definitely not the only thing that can cause a bullseye rash.. ringworm can too. Along with other stuff. I have the rash but dont have lyme disease or ringworm.

  7. Sheila desmarais

    I have a reacuring bullseye rash for several years .i have almost all of the symptoms and getting worse without getting any Drs to explain the rash .the muscle pain .memory problems and on and on …i live undiagnosed and in chronic pain .the rash just came back out again after several yrs of not seeing it .givin some steroid it cleared but is trying to do I get heard .i feel as though I am stuck sitting suffering and ignored.can all this hell all this time I’ve been in be Lyme? What else causescall the same symptoms .How do I get a Dr to listen ? Desperately seeking help

  8. Kelly Hudson

    I have had chronic pain and depression for decades, and spend most of my time in bed. I also have memory problems, which I thought developed from medication.
    Around four years ago, I noticed a red circle with a red centre on my arm. I asked a friend about it and she said it looked like ringworm, so I never mentioned it to anyone.
    A few months ago, I was Googling something, and found myself staring at the exact same mark I’d had on my arm. I went through a few years of waking up soaked in sweat, alternating with chills. The sweating areas were neck, chest, head, groin, and behind my knees. I was exhausted all the time, and couldn’t sleep for more than a few hours at a time. My joints ached, and felt swollen, but didn’t look swollen. I’ve since developed swollen, tender, first joints in my index fingers. I did not have headaches, aside from a few mild ones.
    Is this typical of Lyme disease?

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