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3 Early Warning Signs of Lyme Disease You Shouldn’t Ignore

Cases among adults 65 and older have nearly doubled, latest CDC data finds


spinner image a tick on an illustration of the Lyme disease bullseye rash in shades of pink
AARP (Source: Getty Images)

Warmer weather is settling in, bringing with it sunshine, foliage, and yes, ticks. That’s bad news for folks who enjoy spending spring and summer days outside.

A big reason: Tick-borne diseases are on the rise in the U.S. And a recent report from the Centers for Disease Control and Prevention (CDC) shows that the most common type, Lyme disease, may be a greater burden than previously estimated.

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In 2022, 62,551 cases of Lyme disease were reported to the CDC — that’s roughly 1.7 times the annual average logged between 2017 and 2019. The biggest jump in case numbers was seen in older adults. In 2022, Lyme disease diagnoses among the 65-plus population were more than double what they were in previous years, the 2024 CDC report shows.

A change in how Lyme disease cases are reported and tracked helps explain this significant increase, at least in part, health experts say. Shifting climate patterns, suburban development and a greater awareness among the public are also contributing to rising numbers.

Despite this greater awareness, health experts say many cases of Lyme disease are missed early on, both by patients and health care providers, putting a growing number of people at risk for long-term complications, including severe joint pain, heart palpitations, nerve pain and loss of muscle tone in the face. 

Here’s what you need to know about the early warning signs of Lyme disease, and what to do if you suspect you have it.

1. A rash — but not everyone gets one

It’s a common misconception that everyone with Lyme disease will get a rash in the shape of a bull’s-eye, says John Aucott, M.D., an associate professor of medicine at the Johns Hopkins University School of Medicine and director of the Johns Hopkins Lyme Disease Clinical Research Center.

In fact, only 70 to 80 percent of people with Lyme disease get a rash in the days following a tick bite, the CDC says. And only 20 to 30 percent have the “ring within a ring” rash, Aucott adds. Some people get a rash that’s round or oval, “but they’re often just uniformly red or reddish blue,” he says.

That’s why it’s crucial not to ignore a red skin lesion, even if it’s not a bull’s-eye. “If it’s round or oval and red and it gets bigger than a couple inches in diameter, then that’s suspicious for the Lyme rash,” says Aucott, who adds that a rash can be difficult to see on people with darker skin.

A rash can also be hard to spot if your tick bite was in a less obvious place. “Ticks are smart; they learned where to hide,” says Ross Boyce, M.D., assistant professor of medicine in the division of infectious diseases at UNC School of Medicine. “And so if they go to your hairline or someplace like that, you may not see the rash.”

2. Cold- or flu-like symptoms

In the early days of the disease, especially, symptoms can be what Boyce calls “nonspecific.” You may experience a mild fever, fatigue or body aches. “In the absence of a rash, you might think you have a cold or you just didn’t sleep well last night,” he says.

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One thing to keep in mind, Aucott says, is that unlike a cold, the flu or even COVID, Lyme disease isn’t accompanied by respiratory symptoms like a runny nose, sore throat or a cough. Another tipoff: Cases of Lyme disease are much more common in the spring and summer, whereas respiratory illnesses tend to surge in the fall and winter and peter out in the warm-weather months.

“If it’s May, June or July, and you live in an area where Lyme disease is really common, then that’s when you should be particularly aware and alert to those symptoms,” Aucott says.

Lyme disease is most common in the upper midwestern, northeastern and mid-Atlantic states, according to the CDC.

​​How to Remove a Tick

If you find a tick on your body, ignore the folklore remedies and follow these steps instead. 

  1. Use fine-tipped tweezers to grab the tick as close to the skin as possible and pull upward with steady, even pressure. Avoid twisting or jerking the tick’s body. 
  2. If the tick’s mouth pieces get stuck in the skin, remove them with the tweezers. 
  3. Clean the now tick-free area with rubbing alcohol or soap and water. 

To dispose of the tick:​You can put it in alcohol, wrap it tightly in tape or flush it down the toilet. You can also put it in a sealed bag or container. Hanging on to the tick in this way may help your doctor with a diagnosis, should you get a tick-borne disease, since different ticks carry different diseases.

Source: CDC 

3. The feeling that ‘clearly something’s wrong’  

Whether it’s a slight fever that persists, fatigue or clouded thinking, Boyce says he’s seen Lyme disease patients come in and say, “clearly something’s wrong.”

If you feel that something is off — and after a few days it hasn’t passed — “I think that’s worth going to see someone and getting tested, especially if it’s after you’ve been walking or out in the yard or had some potential exposure to a tick,” Boyce says.

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Worried it’s Lyme disease? Talk to a doctor

Missing or misdiagnosing Lyme disease in the early stages is common, health experts say. The first symptoms overlap with those of many other conditions. What’s more, current lab tests don’t always show the full picture. 

There are blood tests for Lyme disease, but the antibodies the tests pick up on usually take four to six weeks after a bite to register, the CDC says. So an early test may turn up negative, even if you are infected. Still, Boyce says if you live in an area where Lyme disease is common and you’ve been feeling unwell, “it’s a reasonable question” to ask your doctor for a test.

The CDC recommends a two-step testing process, and both tests can be done using the same blood sample. If your doctor suspects Lyme disease or you get a positive test, you’ll be prescribed antibiotics to treat it.

In areas where Lyme disease is common, the CDC says most family and general practitioners are familiar with diagnosing and treating an infection. In areas where Lyme disease is scarce, infectious disease specialists are often the best doctor to see, the CDC says.

Preventing Lyme disease

With diagnosis being especially difficult, Lyme disease prevention is key, health experts say. Aucott is a “big advocate” of wearing permethrin-treated clothing. (Permethrin is an insecticide; you can treat your own clothing or buy pretreated clothing.) And even when temperatures are warmer, Aucott says “it’s a smart idea” to wear long pants and to shower after you come inside and do a tick check.

A few other things to keep in mind:

  • You don’t need to be out for a hike to get a tick bite. Ticks live in grasses and bushes; many people get ticks in their own yard or neighborhood, the CDC says.
  • Don’t forget to check your pets. Ticks love to catch a ride on four-legged family members.
  • Use insect repellents registered with the Environmental Protection Agency.

And remember that Lyme disease is just one tick-borne illness — the bloodsuckers can carry quite a few, including Rocky Mountain spotted fever and alpha-gal syndrome, the red meat allergy that is also on the rise. “So I think, broader consideration for the spectrum of diseases that are out there is worth thinking about,” Boyce says.

Video: Top 5 Tips for Preventing Tick-Borne Disease

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