Lyme disease is a bacterial infection caused by Borrelia burgdorferi that is transmitted through the bite of infected ticks. If left untreated, Lyme disease can lead to serious complications that affect the heart, nervous system, and joints. Understanding how long Lyme can last if untreated is important for prompt diagnosis and treatment.
The Stages of Untreated Lyme Disease
Lyme disease progresses through three stages if not treated with antibiotics:
Early Localized Lyme Disease
The early localized stage occurs within 1 to 4 weeks after a tick bite when the bacteria are still localized to the area around the tick bite. Symptoms include:
- A red bullseye rash known as erythema migrans
- Flu-like symptoms like fever, chills, headache, fatigue, and muscle aches
- Swollen lymph nodes near the tick bite
Without treatment, early localized Lyme can last up to 6 weeks, though symptoms may come and go.
Early Disseminated Lyme Disease
In the early disseminated stage, which occurs several weeks to months after the tick bite, the bacteria begin to spread through the bloodstream to other parts of the body. Symptoms include:
- Additional EM rashes on other areas of the body
- Facial palsy or weakness
- Intermittent arthritis and joint pain and swelling
- Heart palpitations and dizziness due to Lyme carditis
- Nerve pain and numbness
Without treatment, early disseminated Lyme can last weeks to months before progressing.
Late Disseminated Lyme Disease
The late disseminated stage occurs months to years after initial infection if untreated. Bacteria have spread throughout the body. Symptoms include:
- Chronic swelling and pain in large joints
- Neurological disorders like numbness, tingling, tremors, memory issues, and nerve pain
- Heart abnormalities like lightheadedness, fainting, chest pain, and shortness of breath
Late stage Lyme can last indefinitely without antibiotic treatment. Symptoms may come and go but gradually worsen over time.
How Long Lyme Disease Lasts When Untreated
The duration of untreated Lyme disease depends on the stage:
- Early localized: Up to 6 weeks
- Early disseminated: Weeks to months
- Late disseminated: Months to years, indefinitely
Though each stage has a typical duration, not everyone progresses through the stages linearly. Some people have symptoms that fluctuate in severity or seem to skip stages.
According to one long-term study on untreated Lyme disease published in the New England Journal of Medicine:
- After 6 years, 60% of patients with untreated early Lyme still had symptoms like fatigue, joint pain, memory impairment, and peripheral neuropathy.
- After 11-20 years, 20% still had debilitating chronic Lyme disease symptoms.
So while the early stages may last weeks to months, Lyme disease can actually affect patients for years or even decades without antibiotic treatment. Symptoms may eventually resolve in some patients, but others suffer persistent symptoms like arthritis, neurologic impairment, and heart problems.
When to Seek Medical Care for Lyme Disease
If you develop possible symptoms of Lyme disease after being bitten by a tick, seek prompt medical care rather than waiting to see if symptoms resolve. Early treatment with antibiotics for 2-4 weeks can help prevent progression to later disseminated stages.
See a doctor right away if you develop:
- A bullseye EM rash anywhere on the body
- Flu-like symptoms after a tick bite
- Joint swelling or facial paralysis
- Heart symptoms like dizziness or chest pain
- Neurological symptoms like radiating nerve pain, numbness, or memory problems
Catching Lyme disease early allows antibiotics to work better before bacteria spread and cause more damage. This can help you avoid chronic symptoms that affect your quality of life.
Diagnosing Lyme Disease
Doctors use the following approaches to diagnose Lyme disease:
Looking for early signs like rash and checking for enlarged lymph nodes, joint swelling, or heart abnormalities.
Asking about potential tick exposure and onset of symptoms can help identify Lyme.
Serology blood tests check for antibodies your immune system produces in response to the bacteria. These include:
- Enzyme-linked immunosorbent assay (ELISA) or immunofluorescence assay (IFA): Screens for antibodies
- Western blot: Confirms antibodies if ELISA/IFA is positive
You may need multiple tests over several weeks because antibodies take time to develop.
PCR tests that detect DNA from Lyme bacteria are also available.
For neurologic symptoms, doctors may analyze spinal fluid for antibodies and inflammation.
Treating Lyme Disease
Oral antibiotics, usually doxycycline or amoxicillin, are highly effective at treating Lyme disease in the early stages. Common regimens are:
- Doxycycline: 100 mg twice per day for 2-4 weeks
- Amoxicillin: 500 mg three times per day for 2-4 weeks
For later disseminated Lyme with more severe symptoms, IV antibiotics may be given for 4-6 weeks. These include ceftriaxone, cefotaxime, and penicillin.
Though symptoms may not resolve immediately with treatment, antibiotics prevent progression and reduce long-term complications. Most patients see improvement within several weeks to months after starting antibiotics.
Some patients continue to have symptoms like fatigue and muscle aches even after antibiotic treatment. This is known as post-treatment Lyme disease syndrome (PTLDS). It’s controversial whether this is due to ongoing infection or residual damage. These patients may benefit from further antibiotic therapy.
Preventing Lyme Disease
You can lower your risk of contracting Lyme disease with some simple precautions:
- Use insect repellent containing DEET when outdoors
- Wear long sleeves and pants in wooded or grassy areas
- Perform tick checks after being outdoors
- Remove attached ticks promptly with tweezers
- Shower soon after coming indoors
- Talk to your vet about tick prevention products for pets
- Keep grass cut short and bushes trimmed around your home
- Stack wood neatly and away from your house
Spotting ticks early and removing them can prevent transmission of Lyme bacteria. If you develop a rash or other symptoms after a tick bite, see your doctor right away.
Untreated Lyme disease can affect patients for years and lead to chronic complications. Though each stage of Lyme has an average duration, not everyone progresses linearly through the stages, and some suffer symptoms indefinitely. Seeking prompt medical attention after tick exposure allows for early antibiotic treatment to prevent symptoms from getting worse. While no one wants to live with Lyme disease, the prognosis is good if it’s diagnosed and treated early.