Facts About Lyme Disease: 6 Myths You May Encounter With Your Patients

tick on a leaf
tick on a leaf
Myths about lyme disease may present a barrier to prompt diagnosis and treatment. As a clinician, you may encounter these 6 misconceptions.

Every year, approximately 300,000 Americans are diagnosed with Lyme disease.Unfortunately, myths about this widespread disease may present a barrier to prompt diagnosis and treatment. We explore 6 myths about Lyme disease you may encounter with your patients.

Myth #1: No rash means no Lyme

Many people associate Lyme disease with the presence of erythema migrans (EM), with or without a bull’s-eye-shaped rash. While it is true that EM will manifest in the majority of cases, its absence does not preclude Lyme disease. In fact, approximately 20% to 30% of persons infected with Lyme disease do not present with EM.2

Myth #2: If you don’t remember being bitten, you don’t have Lyme

If you don’t remember being bitten by a tick, it doesn’t necessarily mean you’re in the clear. A tick’s saliva contains a numbing agent that can make detecting a bite difficult. Unlike mosquito bites, for example, tick bites tend not to cause immediate itching or skin irritation.3 As a result, ticks can latch onto their host for an extended period of time without being noticed.

Myth #3: If you’re infected, you’ll know right away

Not only might you not notice a bite or rash, any symptoms of Lyme disease you do experience at the outset may be indistinguishable from other illnesses. In the days after a tick bite, you might experience flu-like symptoms including fever, fatigue, chills, headache, and muscle aches.

Myth #4: You can’t get Lyme disease in certain parts of the country

While Lyme disease is prevalent in the Northeast and Midwest United States, it’s not exclusive to those regions.4 In fact, cases of Lyme disease have been reported in all 50 states.5 The disease is also endemic in forested areas of Asia, as well as Eastern, Central, and Northwestern Europe.6

Myth #5: If you test negative, you’re in the clear

The current standard diagnostic test for Lyme disease is two-tiered. Step 1 involves using enzyme immunoassay (ELISA) to measure the number of antibodies produced in response to the Lyme bacterium. If the ELISA test is positive, immunoblot test is used to verify the result. However, ELISA often yields false negatives when antibodies aren’t in great supply. Generally, the accuracy of blood tests increases as the infection progresses, as it may take weeks for the body to launch a detectable immune response.7 

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Myth #6: Antibiotics always cure Lyme disease

A pair of recent studies found evidence that symptoms of Lyme disease may linger after a standard 28-day oral doxycycline regimen and that antibody response “may be inherently unreliable as a singular diagnostic modality for Lyme disease.” The investigators found that 2 in 10 subjects remained infected with Lyme bacteria in the heart and bladder despite negative antibody tests.

Keep Your Patients Informed

Inform your patients that the symptoms of Lyme disease are not limited to a rash, that tick bites are not always noticeable, and that the disease can be contracted virtually anywhere. Recommend that they take precautions such as tucking in pant legs and wearing long-sleeved shirts when venturing into areas that may harbor ticks.


  1. How many people get Lyme disease? Centers for Disease Control and Prevention. Reviewed December 21, 2018. Accessed February 25, 2019.
  2. Signs and symptoms of untreated Lyme disease. Centers for Disease Control and Prevention. Reviewed December 21, 2018. Accessed February 25, 2019.
  3. Heid M. How to know when it’s a tick bite and what to do about it. Everyday Health. Accessed February 25, 2019.
  4. Lyme disease: data and surveillance. Centers for Disease Control and Prevention. Reviewed February 5, 2019. Accessed February 25, 2019.
  5. Searing L. Lyme disease now found in all 50 statesSan Francisco Chronicle. August 5, 2018. Accessed February 25, 2019.
  6. Lyme borreliosis (Lyme disease). World Health Organization. Accessed February 25, 2019.
  7. Marcum L. LYME SCI: analysis shows standard Lyme testing is highly inaccurate. LymeDisease.org. January 13, 2017. Accessed February 25, 2019.