What Are the Long-Term Effects of Lyme Disease, and Does It Have a Cure?

Lyme disease is caused by the bacteria Borrelia burgdorferi. The bacteria spreads through the bite of an infected deer tick. Most people with a tick bite won’t develop Lyme disease. But if the tick carries Borrelia burgdorferi and stays attached for too long, your chance of developing Lyme disease is higher. 

With early treatment, Lyme disease is curable and usually doesn’t cause long-term health problems. But not everyone gets early treatment. Keep reading to review the stages of Lyme disease, treatment options, and the possible long-term effects of Lyme disease. 

The 3 stages of Lyme disease

There are three stages of Lyme disease. Not everyone with Lyme disease will go through all three. Treating Lyme disease in the earlier stages makes it less likely that you’ll progress to the next stage.

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1. Stage 1 Lyme disease

The first stage is called “localized” or “early” Lyme disease. This means the bacteria haven’t spread around your body yet. Symptoms usually start between 3 and 30 days after a tick bite. The typical symptom is a rash called “bullseye” or “target lesion.” 

The rash begins as a red spot where the tick bit you. Over a few days, the rash expands. Sometimes, as the rash grows, it can look like a large, red ring around a smaller red rash — like a bullseye or target. The rash is also called erythema migrans. About 70% to 80% of people with Lyme disease get this rash.

Other symptoms during the first stage include: 

• Fever

• Chills

• Headache

• Stiff neck

• Joint pain

• Muscle aches

• Swollen lymph nodes 

Some people may have these symptoms without a rash. Others may not have any obvious symptoms or rash at all — and they may never know they’ve been infected with Lyme disease.

2. Stage 2 Lyme disease

In the second stage, also called “early disseminated” Lyme disease, the bacteria have spread around your body. It can begin a few weeks to a few months after an untreated Lyme disease infection.

The second stage can show up with a rash, which may look like several bullseye or target rashes. This stage can also affect your nerves, brain, eyes, and heart. These can lead to:

• Meningitis (headaches and fever)

• Facial weakness (Bell’s palsy)

• Pain, numbness, and weakness in certain nerves (radiculoneuritis) 

• Eye problems, like pink eye (conjunctivitis)

• Heart symptoms, like irregular heartbeats or chest pain 

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3. Stage 3 Lyme disease 

The third stage, or “late-phase” of Lyme disease, can happen months to years after the initial infection. In the third stage, the bacteria invade the joints, nerves, brain fluid, or heart.

Arthritis is the most common symptom of late-phase Lyme. It can affect one or more joints. Typically, large joints (like your knees) are the most affected.

If your brain or nerves are affected, symptoms can include: 

• Memory and concentration problems

• Irritability

• Nerve pain, weakness, or numbness in your arms and legs 

Is there a cure for Lyme disease?

Yes, Lyme disease can be cured. The earlier it’s treated, the more likely you are to be cured. Some studies show that 99% of people treated with antibiotics for stage 1 of Lyme disease recover completely. But even if Lyme disease is treated in a later stage, it isn’t permanent. Most people recover with time. But up to 14% of people with Lyme disease keep having symptoms — like body aches and brain fog — even 6 months later (more on this below). 

How is Lyme disease treated?

Lyme disease is treated with antibiotics. The type of antibiotics and the length of treatment depends on the stage of Lyme disease.

Common antibiotics that are used to treat Lyme disease include: 

• Doxycycline

• Amoxicillin

• Cefuroxime

• Azithromycin

The right antibiotics can cure Lyme disease. For early Lyme disease, most people take antibiotics as a pill for 10 to 14 days. People with stage 2 Lyme disease symptoms — like heart or nervous system problems — may need to take antibiotics for 14 to 21 days. They may need intravenous (IV) antibiotics. 

Late-stage Lyme disease usually needs even longer treatment — about 28 days. Some people with late-stage Lyme may also need other medications, like immunosuppressants. If symptoms improve significantly but don’t fully go away, healthcare professionals may recommend a second month of a different oral antibiotic.

If you have pain, your healthcare team may recommend pain-relieving medications like ibuprofen (Advil, Motrin) or gabapentin. 

What is chronic Lyme disease?

For most people, antibiotics cure Lyme disease. But some people still have symptoms for months after treatment. This is known as post-treatment Lyme disease syndrome (PTLDS). 

Common symptoms of PTLDS include fatigue, body aches, and brain fog. Some people call this chronic Lyme disease, but most experts prefer the term PTLDS. This is because the symptoms are from lingering effects — not an active infection.

Scientists are still researching why some people get long-term symptoms and others don’t. They’re also learning about the best treatment. Most people usually get better over time. And physical therapy, yoga, and acupuncture may help ease some symptoms.

What are the long-term effects of untreated Lyme disease?

Untreated Lyme disease can lead to long-term effects on your joints, nervous system, and heart. Below is a closer look at these possible complications.

Joint pain and swelling

About 60% of people with untreated Lyme disease get chronic (long-term) arthritis. Joint pain and damage most commonly occur in the knee. But Lyme disease can also affect other joints, such as the: 

• Shoulders

• Ankles

• Elbows

• Wrists

• Jaw

These joints may feel swollen and warm to the touch. Lyme disease arthritis is more common in older adults with Lyme disease. 

Nerve problems

Nerve problems — like pain, tingling, numbness, and weakness — are another symptom of late Lyme disease. The bacteria can attack nerves and cause inflammation and damage. In early disseminated Lyme disease, the most common nerve symptom is Bell’s palsy, which causes one-sided facial weakness. This usually improves gradually. 

In late-stage Lyme disease, tingling, weakness, numbness, and nerve pain can affect your limbs. This is often harder to treat. 

Thinking and memory problems

Untreated Lyme disease can cause inflammation in the brain tissue. This leads to problems with memory and concentration. 

Heart problems

Lyme carditis (heart inflammation) can happen when the Lyme disease bacteria enter your heart and cause inflammation. There are a range of symptoms, depending on which part of the heart Lyme affects. Lyme carditis can include problems like: 

• Myocarditis: Heart muscle inflammation

• Pericarditis: Inflammation of the lining around your heart

• Heart block: Interruption of the electrical circuits that control your heartbeat

• Palpitations: Sensation of fast and irregular heartbeat

• Heart failure: Buildup of fluid related to heart failure, which happens when your heart can’t pump effectively and properly

Can Lyme cause permanent damage?

Without treatment, Lyme disease can cause permanent damage. Lyme disease itself isn’t permanent. But sometimes infection with Lyme disease can cause damage to joints and your nervous system that may not go away. 

Most people with late-stage Lyme disease can recover if they get treatment with antibiotics. But the longer you wait to start treatment, the longer it can take for symptoms to go away.

A small subset of people may continue to have symptoms that persist after treatment. Some long-term complications include: 

• Synovitis: This is inflammation of the linings of your joints. Up to 1 in 10 people with late-stage Lyme have visible joint inflammation, even after antibiotic treatment. Immunosuppressive medications or surgery can sometimes help to reduce pain.

• Encephalitis, encephalomyelitis, or encephalopathy: These are types of brain and spinal cord inflammation. They can cause long-standing problems with movement and thinking. These symptoms rarely persist after treatment.

• Neuritis or neuropathy: This is inflammation of the nerves outside of your brain, throughout your body. It can cause long-lasting problems with feeling (sensation) and muscle strength (power). These symptoms rarely persist after treatment.

• Post-treatment Lyme disease syndrome: People often call this “chronic Lyme disease” or “post-Lyme syndrome.” It's similar to fibromyalgia and chronic fatigue syndrome. Symptoms include fatigue, widespread musculoskeletal pain, and problems with thinking and concentration. 

Preventing Lyme disease

To help prevent Lyme disease, you should focus on avoiding tick bites. This is especially important if you live in an area where ticks are more likely to carry the bacteria that causes Lyme disease. 

Lyme disease is most common in the Northeast, mid-Atlantic, and upper Midwest regions of the U.S. If you live in or visit these areas, it’s important to take extra precautions. 

To help prevent Lyme disease, you can:

• Try to avoid tick bites. Use insect repellent when outdoors. You can also wear long sleeves, tuck your shirt into your pants, and tuck your pants into your socks. This reduces exposed skin for ticks.

• Check for tick bites after a day outdoors. If you find any ticks, remove the tick immediately. 

• Consider preventive antibiotics after a tick bite. Ticks that are attached for more than 36 hours and filled with blood are more likely to lead to Lyme disease. Talk to a trusted healthcare professional if you get a tick bite and live in an area where Lyme disease is common. 

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Written by:

Claire Wilcox, MD

Claire Wilcox, MD, has 20 years of experience in her field. She was an associate professor at the University of New Mexico, where she is currently a part of the adjunct faculty.

Edited by:

Alex Eastman, PhD, RN

Alex Eastman, PhD, RN, is a California-based registered nurse and staff medical editor at GoodRx, where he focuses on clinical updates and Latino health.

Reviewed by:

Karen Hovav, MD, FAAP

Karen Hovav, MD, FAAP, has more than 15 years of experience as an attending pediatrician in a variety of clinical settings. She has worked in a large academic center in an urban city, a small community hospital, a private practice, and an urgent care clinic.

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