▷ The Four Stages of Lyme Disease

The Four Stages of Lyme Disease

By Melissa Lind / August 22, 2018
Tick crawling on human skin

Lyme disease is caused by a bite from a tick which is infected with Borrelia burgdorferi bacteria. The deer tick is the most well-known carrier of Lyme disease but the bacteria may be carried by Western black-legged ticks as well. There are at least 30,000 confirmed Lyme infection cases in the US each year. See the infographic below for some basic stats.

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Lyme Disease Infographic:

Lyme Disease Infographic

Lyme disease is a progressive illness occurring in three stages, and ending in a fourth, chronic phase. Progression through the stages of Lyme disease in humans can take a number of months or in some cases, years. Many people with Lyme disease are unaware that they have the infection in the early stages.

Stage 1 Lyme Disease

Symptoms of Lyme disease may begin a few days or weeks after infection. In many cases, you may not know that you have been bitten as ticks that carry Lyme disease are very small and their bites painless.

Stage 1 Lyme Disease Symptoms

Stage 1 is also called “early localized Lyme disease” and may last for 1 to 4 weeks. You may have symptoms including:

  • A circular rash that may expand over time (erythema migrans), which may also have a bulls-eye appearance
  • Flu-like symptoms, such as:
  • Fever
  • Chills
  • Joint and muscle pain
  • Stiff neck and headache
  • Fatigue
  • General feeling of illness
  • Swollen lymph glands

Symptoms of stage 1 Lyme disease may not always be present. In some cases, Lyme disease symptoms may come and go.

The rash that occurs with Lyme disease at the site of the tick bite is typically present in fewer than 50% of cases. The rash itself is not usually itchy or be painful but may be warm to the touch. In people with light colored skin, the rash may appear to be pink or red, those with darker skin may have a rash that looks more like a bruise.

Tick bite

Source: Flickr Creative Commons

In most cases, the rash will go away in four weeks but other symptoms may persist or get worse. They often also go dormant for a while, only to emerge later in more severe ways. If Lyme disease is not treated during this stage, it will go on to stage 2 which can affect other areas of the body.

Stage 1 Lyme Disease Treatment

Lyme disease may be treated during stage 1 with a course of antibiotics such as:

  • Doxycycline
  • Cefuroxime
  • Amoxicillin

Unfortunately, unless the tick bite was documented with the tick being positively identified and a rash is clearly present, it is difficult to confirm Lyme disease and physicians who are not Lyme-literate may be hesitant to prescribe treatment. Often acute cases resemble a "flu-like illness" potentially with a localized rash which may or may not be in a bullseye shape. Known laboratory testing for Lyme disease relies on antibody production which may not occur until several weeks after infection.

In some rare cases, a single dose of doxycycline may be used if all of the following requirements have been met:

  • A tick is attached to the body or has been removed and can be identified
  • The tick was attached to the body for more than 36 hours
  • Medication can be started within 72 hours of tick removal
  • More than 20 percent of ticks in the area are known to carry the bacteria Borrelia burgdorferi
  • The patient is over 8 years of age and not pregnant or breastfeeding

Dr. Eric Wood, ND

The Naturopathic Doctor says...

"Clinically, I wouldn’t be comfortable prescribing such a short course. Evidence suggests ticks can transmit within four hours of a bite and the life cycle of the disease is long--nearly four weeks. If a patient has been infected and given just a single dose, odds are high it won’t kill everything, leaving a false sense of 'clearance' and potentially a latent, brewing infection."

Stage 2 Lyme Disease

The second stage of Lyme disease is called Early Disseminated Lyme Disease. It may occur weeks to months after infection. Stage 2 symptoms can range from mild to severe – or you may not notice them at all. A strange disease indeed.

Stage 2 Lyme Disease Symptoms

Symptoms of Stage 2 Lyme disease may include:

  • Flu-like symptoms - similar to or worse than those in Stage 1
  • Fever, chills, joint and muscle pain, stiff neck and headache
  • Swollen lymph nodes or glands
  • Fatigue
  • Sore throat
  • Visual disturbances such as blurry vision
  • Paralysis or weakness in the face
  • Pain or numbness in the bite area
  • Heart palpitations

As with stage 1, not everyone with stage 2 Lyme disease will have notable symptoms. In some cases, the disease is obvious but in other cases you may feel completely well regardless of how severe the stage 1 symptoms were.

Stage 2 Lyme Disease Treatment

Lyme disease infection may be confirmed by laboratory testing which detects antibodies in the bloodstream but not all patients with Lyme will test positive for the infection and without positive laboratory confirmation, many physicians will be reluctant to prescribe treatment. There are now many other testing methodologies that are utilized besides just antibody testing, which in combination make this testing more accurate and reliable. The better labs use ELISA, PCR, antibodies and possibly more all in one combined profile. 

Close-up photo of an engorged tick

Source: Flickr Creative Commons

If treatment is prescribed, antibiotic treatment for Lyme disease during stage 2 usually involves a course of oral antibiotics such as azithromycin, doxycycline, amoxicillin, or cefuroxime. Doxycycline should not be given to children under eight years of age or to nursing or pregnant women. In other cases, a 10 to 30 day course of IV antibiotics such as ceftriaxone may be prescribed.

How to Kill Ticks Naturally

Keep your family safe from Lyme disease...

Stage 3 Lyme Disease

Also called Late Disseminated Lyme disease. This stage of the disease occurs when the infection has not been treated during stage 1 or 2. It may start months or even years after the original tick bite.

Stage 3 Lyme Disease Symptoms

Symptoms of Stage 3 Lyme disease often include:

Ticks on wheat

Soucre: Flickr Creative Commons

  • Severe headaches
  • Arthritis of the large joints (knees, hips, etc.)
  • Heart arrhythmia
  • Brain disturbance including memory loss, mood disturbances and sleep interruption
  • Difficulty concentrating and mental fogginess
  • Temporary amnesia
  • Difficulty following conversations or speaking
  • Numbness or tingling in limbs (arms, legs, feet or hands)
  • Extreme fatigue
  • Temporary paralysis of facial muscles

The presence of a Lyme disease infection can usually be detected through laboratory testing at this stage by identification of antibodies in the blood stream. That is, unless immunosuppression has happened. Chronic infections tend to suppress antibody production because of immune system depletion. In addition, symptoms of Lyme disease may appear to be similar to other conditions and may not all occur at the same time.

Stage 3 Lyme Treatment

Fighting Lyme disease long term is more difficult and unfortunately there aren't a variety of well-understood treatment options once the disease progresses. Treatment at this stage is typically the same as in the first two stages, involving a course of antibiotics for traditional allopathic treatment. Integrative or holistic practitioners have a variety of other ways to treat tick-borne illnesses such as herbs, vitamins, diet changes and detoxification therapies.

Stage 4 - Chronic Lyme Disease

Chronic Lyme disease may also be referred to as chronic Lyme arthritis. It is a recurrent form of joint inflammation which may include episodes of severe arthritis symptoms. The most common joint affected is the knee joint but it may also occur in other large or small joints as well.

Woman with Lyme Disease
Stage 4 Lyme Disease Symptoms

Late stage Lyme disease (arthritic) symptoms may include episodes lasting 6 months or more of:

  • Swelling
  • Redness
  • Fluid buildup

Lyme disease is thought to be fairly easy to treat during stages 1 and 2, and more difficult but still treatable during stage 3. Unfortunately, many patients are not appropriately diagnosed and do not receive timely or appropriate treatment and many physicians are not trained in the management of acute or chronic late stage Lyme disease.

Additionally, some patients will experience severe Lyme arthritis even after eradication of the infection, as the immune system may have “turned on itself” and began attacking the joint tissues, effectively causing an auto-immune reaction.

Dr. Eric Wood, ND

The Naturopathic Doctor says...

"Another major issue missed in Lyme disease is the component of 'biotoxins' which are toxic poisons produced by the Borrelia bugs. This adds a whole major layer to the treatment necessity and protocol that is seldom addressed."

Stage 4 Lyme Disease Treatment

Persons who believe they have or have had Lyme disease should seek treatment for chronic Lyme disease from a physician with experience treating the disorder.

This is just the start of what you need to know about Lyme disease. Take a look at our Lyme disease topic page to get a fuller education on the subject.

About the author

Melissa Lind

Melissa Lind holds a degree from the University Of Texas College Of Pharmacy and has over 20 years of experience in the healthcare field including pharmacy practice, clinical research and community college instruction. Melissa has been freelance writer and health-blogger, specializing in health and lifestyle topics since 2006 and has been published on sites such as eHow.com, Livestrong.com and Livewell.com.

Chris - January 20, 2018

You know I’ve read a lot of articles like this one.. The problem is, finding a physician who has a heart and ethical is impossible. Plus they’re honestly half ass pharmacists, as I wouldn’t want to dishonor the trained pharmacists. Its a joke the medical system, I have begged for 30 plus years for someone to test me for this type of stuff. It falls on deaf ears, as all you get in the end is arthritis pills!! Everyone self medicated in this country, does anyone even care about another human anymore? Our health care system us full of ambitious greedy uncaring people, not there to serve, but to simply make money.. Teachers the same thing.. I feel for all the undiagnosed folks out there, it has ruined my life all these years, I have 0 friends and family all turn on you when ur sick.. Oh well, nobody ever even comments back, so ill shut up..

    Sherry - January 21, 2018

    Find a natural path who specializes in Lyme. My daughter suffered almost ten years b4 I found a good Natural Path to test her and came up positive just as I knew it would. Don’t give up

    Jessica Frausto - January 23, 2018

    I’m sorry for your pain and suffering. I’m just a average Jane. Reading up on what my husband has been told he has.

    Rich Bergstrom - February 20, 2018

    Chris: I agree with you and I too have stage 4 Lymes disease. Please contact this website : https://www.chunginstitute.com/

    They are the best in the East Coast for treating Lyme disease. Tell them Rich Bergstrom recommended you to them. I e been going to Dr. Chung for 2 years and I have one of the worst cases of Lymes that he have ever seen and I am now getting brought back to life. Fabulous doctors nd staff.

    ernesto - April 29, 2018

    You can cure your disease using MMS . there are a lot of testimonies, please watch this video as an example https://www.youtube.com/watch?v=MgAZ_3h1pMI

    Laura J. - May 10, 2018

    Chris, I couldn’t agree with you more! The medical field is a greedy industry and I can honestly say that with no hurt in my heart since I’ve spent over 30 years providing service to those in need from this field. It saddens me to the core, but I decided to leave a PCP for the simple reason of him not listening to me as a person, but as a “complainer” instead. To boot the Physician in the group I’ve changed to is actually not much better since she only wants to send you to every Tom, Dick and Harry (Sorry for those of you with those names!!) “since she doesn’t deal with those specialties”..I wanna know then: Why did you become a Dr. in the first place?? Bitten and all the classic signs of Lyme’s Disease, but treated late over 12 years ago and now having EVERY SINGLE SYMPTOM OF STAGE 4 Lyme’s Disease Is So Obvious!! It’s so “Black and White” to me, But no one wants to do the testing or admit it..they all want to call it something else and it is soooooo frustrating. They are not the ones living with the constant pain and every other symptom that goes with it either…being only 53 and dealing with all this for the past 12 years has been a real shit parade and I’m so tired of fighting it alone. I know I’m not alone, but it just “SUCKS!!!” We just need reform now more than ever in our medical field to help those who aren’t getting what they need, but I honestly don’t see it happening any time soon…I’m with you on every single thing..”Oh and Please don’t ever shut up..See I commented Back it was a rant, but a comment none the less!!!” 😉

      Raymond Northrop - January 25, 2020

      Please read my comment of Jan. 17,2020, It really happened. The President just signed the “Kay Hagen Tick Legislation” and I have sent him a letter in support. I hope that you and many other will do the same. Everything that has been said here is true and we can all hope for a cure.

      Ray N.

    Diane - September 11, 2018

    To Chris, DITTO !!!

    Sylvia - September 18, 2018

    Hey Chris
    I hear exactly what your saying as I too have suffered 15 years plus.
    There is very little help out there especially for those who have chronic Lyme – it’s a crying shame many have to go private to get true results and a treatment plan to follow.
    How are you now?
    Are you under a LLMD for any treatment?

    Colette - September 22, 2018

    Your so right . It’s like getting a degree that you didn’t go to school for or ask for with this stuff. You find yourself being your on affidavit when you get Chronic Lyme. You better be when drs don’t know about it around you. It’s bad when a dr suggest to talk to you when someone he has seen get this and say you know more about it and what to do than he does in your town because you have it so bad. You be allowed to get this disease this bad you don’t have any answers, no dr to turn to for help because one, insurance isn’t going to pay for any LLMD or their treatment. You will be so screwed if you relay on your family physican to find and treat it . I could go on and on with this. Waist of time . Nothing good or promising for people with Chronic Lyme. Not being negative just honest.

    Christine - January 20, 2019


    I read your comment. You are not alone. I lost so much due to Lyme disease, but I got help outside the b.s. medical system. Don’t waste time or money there.

    I have been healing/working on my health for the last two years and I am almost cured.

    I had the final stage of neurological Lyme. I was undiagnosed for four years before I got real help.

    Traditional doctors don’t know or understand anything about chronic illness, autoimmune disease and how to heal. They know even less about this disease.

    I going to be very honest with you. It takes sometimes a couple years to recover and you have to change your life. It is up to you. You will need to change your lifestyle in order to get your life back. I was willing to eat dirt if it helped.

    I almost died listening to doctors. They are clowns.

    Found a functional medicine doctor.

    Her name is Dr. Serena Satcher.

    If you value your health, please look her up at

    “Treat yourself to health”

    Also start reading tired of Lyme website for guidance.

    I am praying for you. I am telling you I was as sick as they come. I am now leaving this hell behind and moving on with my young adult life. Already lost the first four years of my 30’s.

    Don’t lose anymore time!

    Cindy D May - March 7, 2019

    Chris, it’s a year later. I don’t know if you’re still needing help for Lymes? The very best thing I’ve found that absolutely works for hundreds of people (will be thousands sooner than later) is MicrobeFormulas.com . The founder had Lymes for more than 10 years. So he researched and put this protocol together.

    I was in a group for candida (found out candida, Lymes, Morgellons, Mold Infections and Bacterial Inections are all in the same grouping–fungal overgrowth that lives inside parasites). I knew I had severe systemic candida, but didn’t know I had parasites. For the last 8 months I’ve been dumping loads of them daily. I’ve used only one of their products so far–it’s their flagship I’d say.

    Mimosa Pudica. The customer service is awesome. I’ve called several times and spoken for 30 min to an hour. There are no fillers or excipients. It’s organic and non-GMO. So many people from Lymes (and candida) getting healed through this. I wish you the best and hope this helps!! Cindy

    Daniel Kelly - July 9, 2019

    I absolutely concur with your observations and feelings of uncaring physicians.
    I was recently bitten by a deer tick after working in my neighbor’s yard for a few hours. When I returned home to clean up and shower, I found a 1/2 inch perfectly round, red ring with a small dark center. It was a deer tick, my wife removed the tick with tweezers and we applied alcohol and a triple antibiotic ointment. I was seen by my PCP four days later. He prescribed Doxycycline Hyclate and told me if I’m ever bitten again to seek medical attention immediately.

    Raymond Northrop - January 17, 2020

    To Chris, Laura J. and all of you that are suffering from Stage 4 Lyme. I have no doubt that many of you still won’t believe what I am going to tell you but you still need to know.
    I was infected with a disease that is now known as Lyme disease in 1959. That is 15 years before Lyme disease had a name. I was in the Service and was sent to West Point New York, that was the time the DOD was experimenting with weaponizing insects for possible warfare. I have now had it for 60 years. All of the comments listed here are all too familiar. I have had them all. I went to the Mayo Clinic in 1989 and came away with the all to familiar “We can’t find anything wrong”. I have had multiple blood test including the Western Blot Test but nothing ever tests positive. Been trying to get an appointment with John Hopkins Clinic but can’t seem to get a referral. They specialize in Lyme Research.
    There are two books that shines the light on Lyme “Bitten” by Kris Newby and “Lab 257” by Michael Carroll. These documentary books will scare the life out of you. They have proven what I have been saying for 60 years.
    If you have Chronic Lyme, you are truly alone. The medical profession is still 60 years behind.

    Belinda Salyer - January 30, 2020

    I understand! And I don’t get why a doctor won’t just test. I doesn’t cost them. They charge us out the a@@. Anyway I understand

    Jennifer McDonald - November 11, 2020

    Hi Chris, Did anyone end up relying to your message? I can totally relate. I’ve had Lyme for probably 30 yrs and I’m 56 now. Totally ruined my life, friendships and career. My family even tell me they are tired of me being sick. Totally breaks my heart. I mean, do people think I choose this life!!!.. Anyway, I know you posted your message nearly 3 yrs ago. But I wanted to reply as I feel the same way as you. I have been diagnosed by a good Doctor. He is in whole health Utah. But because I have chronic Lyme its still and on going battle with treatment as my body is so weak it doesn’t take treatment well. I wish you luck on the rest of your Lyme journey. I’ll be praying for you friend.
    Jen 🙂

▷ 7 Ways to Kill Ticks Naturally in Your Yard - January 21, 2018

[…] had a protracted struggle with Lyme Disease that continues to this day, so I recognize that my tick paranoia is borderline pathological. So is […]

matt odaly - December 1, 2018

matt odaly I have been tested positive limes several times in past years treated doxycycline 200 21 days did not work had it to long hav no health ins so lived with it then got bit again white star back tick again had to wait till I could buy doxy on line several months later no money for doctor took 300 mil a day for30 days helped knees but still can barley move my fingers mostley when I wake up please tell me what I can do if u can my e mail is real but don’t no how get them off my phone tex is good 6317285818 please help if u can

Eric - August 6, 2019

There’s many natural ways to beat Lyme Disease or stop it from flaring up. Eat lots of Garlic, Lemon, Parsley, Pineapple, Turmeric, Basil, Kale, Coconut, Folate which is found in Beets, take Coenzyme Q10, Omega 3 fatty acids, Vitamin A, B, C, and D pills. Magnesium pills. etc. These natural things may have an impact on Lyme in your system.

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