7 Factors That Can Delay a Lyme Disease Diagnosis

Medically Reviewed By William C. Lloyd III, MD, FACS
Written By Elizabeth Hanes, RN on September 6, 2020
  • Close-up of tick on fingertip
    Why can it take so long to diagnose Lyme disease?
    Named for the town in Connecticut where it first arose, Lyme disease (also known as Lyme borreliosis) can cause serious symptoms like arthritis, facial palsy, and even brain inflammation. Lyme disease usually can be treated with antibiotics, but a Lyme diagnosis can take weeks or even months to confirm. Why so long? These seven factors can make it difficult and time-consuming to get an accurate diagnosis—and to get started on Lyme treatment.
  • Older woman wearing scarf holding hand on forehead with headache or fever
    1. Common Lyme symptoms match those of other conditions.
    If an infected tick gives you Lyme disease, the most common initial symptoms include headache, fever, body aches and fatigue. Sound familiar? This list should ring a bell, because these symptoms also typically indicate flu and other illnesses. Your healthcare provider will try to rule out the most common reasons for this group of symptoms before moving on to less-likely possibilities like Lyme. Once it’s clear you don’t have the flu or some other illness, then your practitioner may start to consider Lyme disease as the culprit. However, it can take time to reach that point.
  • Close-up tick in palm of hand
    2. You probably don’t know you were bitten.
    Lyme is transmitted by black-legged ticks (also called deer ticks), and if you went to your doctor with a tick embedded in your skin and later developed Lyme symptoms, diagnosis would be easy. But that’s not usually the case. Deer ticks are tiny—only about the size of a sesame seed. Their bite is painless, and they can detach from your skin and disappear before you’re even aware of it. To speed up a possible Lyme diagnosis, be sure to tell your provider if you’ve been hiking in the types of wooded areas that harbor deer ticks, even if you don’t believe you were bitten.
  • close-up of bullseye lyme disease rash on leg
    3. You may not develop the classic “bull’s-eye” rash.
    The tick bite that causes Lyme disease can cause a round, red rash to spread from the bite site over the course of days. Often, the bite location fades to a pale white, producing a distinctive “bull’s-eye” effect that can be used to diagnose Lyme disease. However, many people with Lyme disease never develop this rash. Absent this telltale sign of Lyme, healthcare providers must use other, more time-consuming methods to diagnose the illness and start you on appropriate Lyme disease treatment, usually antibiotics.
  • close-up of tick on green leaf
    4. Ticks that transmit Lyme also carry other diseases.
    The ticks that transmit Lyme disease also can carry a host of other diseases that cause the same early symptoms as Lyme disease. Black-legged ticks can infect you with anaplasmosis, babesiosis and Borrelia miyamotoi. All of these illnesses start with fever, chills, headache and other flu-like symptoms. Ruling out these other possible tick-borne diseases can delay diagnosing Lyme disease, but your provider must take these steps to make sure you receive an accurate diagnosis and can begin the appropriate treatment.
  • Middle age woman standing at chalkboard calendar smiling over shoulder with work colleagues
    5. Lyme disease symptoms can take months to fully develop.
    The first symptoms of Lyme disease often develop within three days of the tick bite, but they can take as long as 30 days to emerge. And advanced symptoms like facial droop or arthritis may take months to develop. The speed of diagnosis may hinge on how quickly—and how many—symptoms develop. Even a highly skilled healthcare provider might rule out Lyme disease early in the process and then rule it back in months later, after new symptoms appear.
  • Man showing bandage on arm where blood was drawn for blood test
    6. The Lyme disease blood test isn’t accurate until four weeks after a tick bite.
    A healthcare professional can diagnose Lyme disease based on the distinctive “bull’s-eye” rash alone. But if the rash has cleared up by the time you seek medical care—or if you never developed a rash to begin with—your provider will need to administer a blood test to check for Lyme bacterium antibodies in your blood. However, administering the blood test too early can cause false negative results because it takes your body at least a month to produce Lyme antibodies. As a result, doctors may need to wait up to four weeks to perform a blood test if they suspect a Lyme diagnosis.
  • Young African American woman smiling talking to friend at restaurant
    7. Symptoms of Lyme disease can come and go.
    In many cases, the common symptoms of Lyme disease will appear and disappear over the course of months or even years. When the symptoms clear up, you may think it’s not Lyme disease after all, but rather a temporary illness like the flu. However, if there’s any chance you were exposed to the bite of a tick carrying Lyme, you should see your healthcare provider to start the diagnostic process as soon as symptoms emerge. Left untreated, Lyme disease can cause serious complications that affect your brain and nervous system. And if you receive antibiotics to treat your Lyme disease, be sure to complete the full treatment course, even if your symptoms go away.
Lyme Disease Diagnosis | 7 Factors That Can Delay Lyme Treatment

About The Author

As “the nurse who knows content,” Elizabeth Hanes, RN, works with national and regional healthcare systems, brands, agencies and publishers to produce all types of consumer-facing content. Formerly a perioperative and cosmetic surgery nurse, Elizabeth today uses her nursing knowledge to inform her writing on a wide variety of medical, health and wellness topics.
  1. Lyme Disease. U.S. National Library of Medicine, MedlinePlus. https://medlineplus.gov/lymedisease.html
  2. Lyme Disease. American Academy of Family Physicians. https://familydoctor.org/condition/lyme-disease/?adfree=true
  3. Lyme Disease Co-Infection. U.S. National Institute of Allergy and Infectious Diseases. https://www.niaid.nih.gov/diseases-conditions/lyme-disease-co-infection
  4. Lyme Disease Data and Statistics. U.S. Centers for Disease Control and Prevention. https://www.cdc.gov/lyme/stats/index.html

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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2020 Sep 6
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