Can you get Lyme disease more than once?

Medically reviewed by Neka Miller, PhD on August 11, 2020. To give you technically accurate, evidence-based information, content published on the Everlywell blog is reviewed by credentialed professionals with expertise in medical and bioscience fields.

Table of contents

• Is it possible to get Lyme disease again after you’ve already had it?
• Clinical signs and symptoms of Lyme disease
• How to avoid Lyme disease
• Steps for tick removal
• Related content

If you’ve been infected with the Lyme bacterium before, you might be wondering: can you get Lyme disease twice? (Lyme disease is caused by an infection from bacteria called Borrelia—which can be spread to humans through the bite of an infected blacklegged tick.)

Read on for the answer to that question—along with some helpful tips for preventing tick bites and Lyme disease. (To test for Lyme disease from the convenience of home, take the Everlywell at-home Lyme Disease Test.)

Is it possible to get Lyme disease again after you’ve already had it?

Can you get Lyme disease twice—or more? The answer is yes, you can. Even if you’ve already had Lyme disease (and received treatment for it), you can get it again if you’re bitten by an infected tick carrying Lyme bacteria. Protecting yourself from tick bites is one of the best ways to prevent Lyme disease—regardless of whether you’ve had it before. (Related: What are the chances of Lyme disease after a tick bite?)

Read our article “What to do if you are bitten by a tick” to learn some steps you can take in case you are bitten by a tick, and—if you’re interested in checking for Lyme disease—keep in mind that you can take a Lyme disease blood test from the convenience of home.

Clinical signs and symptoms of Lyme disease

Before diving into the details of how to avoid getting Lyme disease, let’s first highlight some of the most common symptoms of Lyme disease.

Early Lyme disease

• A characteristic skin rash, called a bulls-eye rash or erythema migrans A reddish, purple rash that occurs within a week or two after the bite of an infected tick and looks like a round or oval bull's eye
• Fatigue
• Chills and fever
• Headache
• Muscle and joint pain
• Swollen lymph nodes

Early diagnosis of Lyme disease—and prompt treatment with antibiotics—can help prevent late Lyme disease, which is often associated with more severe symptoms.

Late Lyme disease

If Lyme disease isn’t treated in its early stage, it can progress to late Lyme disease and include the following symptoms.

• Arthritis, especially in large joints like the knees
• Nervous system symptoms, like numbness, pain, and nerve paralysis
• Irregular heartbeat
• Problems with memory or concentration
• Sleep disturbances

How to avoid Lyme disease

From familiarizing yourself with environments where Lyme-transmitting ticks thrive to knowing how to rid yourself of a pesky tick once it’s attached, here are some tips to help avoid this infectious disease.

Learn how to recognize the blacklegged tick

There are 700 species of hard ticks and 200 species of soft ticks found throughout the world. Of all these different species, what ticks carry Lyme disease bacteria? It’s deer ticks or blacklegged ticks (Ixodes scapularis) that transmit Borrelia burgdorferi (the bacterium that causes Lyme disease).

They can also transmit Borrelia mayonii (which causes a Lyme-like illness), Borrelia miyamotoi, Borrelia hermsii, Ehrlichia muris (which causes ehrlichiosis), Anaplasma phagocytophilum (the cause of anaplasmosis), Babesia microti (the cause of babesiosis), multiple species of rickettsia, deer tick virus, and Powassan virus.

Blacklegged ticks typically have a reddish-orange body; black shield; and dark, black legs. Ticks across several different stages of development can transmit Lyme disease bacteria, with nymphal ticks and adult female ticks most commonly found on people.

Understand how the life cycle of a tick relates to Lyme disease

There are four developmental stages in the life of a tick. Becoming familiar with the tick life cycle is helpful, as the majority of Lyme disease infections are transmitted by tick nymphs.

Tick larvae

Tick larvae are tiny—so tiny that it’s almost impossible to spot them on your clothes. In this stage, the ticks are not known to transmit tick-borne diseases.

Tick nymph

Nymphal ticks are about the size of a poppy seed. They’re small and their bite is painless, which means they often go undetected. When they’re in the nymph stage, ticks are most active in the late spring and summer. As we mentioned previously, this is an important stage to be aware of, as tick nymphs are primarily responsible for transmitting Lyme disease infections.

Adult ticks

Adult ticks have a flat shape and are roughly the size of a sesame seed. Adult ticks that carry Lyme disease feed and mate mostly on deer and can be found on dogs, horses, and domesticated animals. But they can certainly bite humans, as well, and transmit Lyme disease bacteria.

Familiarize yourself with the most common regions where Lyme disease occurs

For Lyme disease to occur the environment must have both blacklegged ticks and animals infected with Lyme disease bacteria. In the United States, the Eastern states have the highest rate of infection, especially New England and the mid-Atlantic and Northern midwestern states—especially Wisconsin, Minnesota, and the Great Lakes region. Lyme disease occurs less frequently on the West Coast, but when it does, it’s mostly in northern California and sometimes Oregon and Washington.

Be aware of where ticks attach themselves

To avoid tick bites, it helps to know where ticks attach themselves in the body. That way, when you’re doing a self-inspection after returning from a hike or spending time outdoors, you can know what areas to focus on.

While ticks can attach to any part of the human body, they prefer hard-to-see areas like the scalp, armpits, and groin. Remember that for Lyme disease bacteria to be transmitted, the tick generally must be attached for 36-48 hours. Finding any ticks as soon as possible may help decrease your chances of Lyme disease after a tick bite because infected ticks are more likely to transmit Lyme bacteria the longer they’re attached.

Be especially cautious during tick season

Ticks that carry Lyme disease are active year-round. They can survive in temperatures below freezing, though their peak season of activity runs from April through September. During this time, the nymphal tick seeks a host and its bite comes with the greatest risk of contracting the disease.

Practice tick awareness

To help prevent Lyme disease, the Global Lyme Alliance has provided helpful information to help us all be more tick AWARE—an acronym that’s explained below. Whether you’re out walking your dog in tall grass or going on a hike during vacation, implementing these tactics may help decrease your risk of Lyme disease.

A stands for avoid. Essentially, you want to avoid all areas that ticks populate. Ticks thrive in stone walls, leaf litter, woodpiles, long grass, beach grass, bushy areas, and the perimeters where the woods meet the lawn. When you’re exploring nature, it’s easy to get caught-in-the-moment with exploration. But, by practicing the habit of avoiding tick-prone areas, you’re protecting yourself from a potential bite.

W stands for wear. When you’re venturing outdoors, clothing is key for tick bite prevention. Aim for light-colored clothing that makes it easier to spot ticks when they’re climbing onto you. A long-sleeved shirt tucked in at your waist and long pants tucked into high shoes will help keep the ticks out, as will closed-toed shoes. If possible, wear a hat with your hair tucked in. Do not walk in grass barefoot or in open sandals. This is an important rule to follow even if the grass is cut short (as ticks can still be found in short grass).

A stands for apply. An EPS-approved tick repellent (like DEET or picaridin) and insecticide (like permethrin) is suggested for applying to skin, clothing, and shoes.

R stands for remove. You want to remove your clothing upon entering your home. Putting clothes into the washing machine will not kill live ticks. But putting them into the dryer for 10-15 minutes at a high temperature will.

E stands for examine. You want to examine yourself and your pets for ticks on a regular basis. Ticks love to hide, so remember to check everywhere throughout your body. Feel around for bumps, but also check the backs of the knees, groin, armpits, in and behind the ears, belly button, and scalp. Take a shower or bathe as soon as you can so you can wash away any unattached ticks.

Steps for tick removal

If a tick does bite you, a loved one, or a pet, there are a few key steps to take to remove the tick while minimizing the risk of infection. You want to remove the tick as soon as possible using fine-pointed tweezers or specialized tick-removal tweezers, using these steps:

1. Grasp the tick at the place of attachment, getting the tweezers as close to the skin as possible.
2. Pull the tick out gently and in a steady, upward motion with even pressure. Do not squeeze, jerk, or twist.
3. Don’t touch the tick with bare hands.
4. Wash your hands with soap and water. Apply rubbing alcohol or antiseptic to the bite.
5. If possible, bring the tick to a local health department to help determine what kind of tick it is. You can place it in a zippered plastic bag with a moist cotton ball.
6. If you notice a rash, take a photo and document your Lyme symptoms and seek medical attention as soon as possible.

If you suspect you’ve been exposed to an infected tick and are suffering from Lyme disease symptoms, our at-home Lyme Disease Test can help you learn if you may have a Lyme infection. (Note that this test should not be taken if you have the bulls-eye rash, since this is a clear physical sign of Lyme disease and you should speak with a healthcare provider right away.)

Related content

What are the chances of Lyme disease after a tick bite?

How accurate are Lyme disease tests?

Types of ticks that carry Lyme disease

References

1. Lyme disease. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/lyme-disease/symptoms-causes/syc-20374651. Accessed August 11, 2020.

2. Nadelman RB, Hanincová K, Mukherjee P, et al. Differentiation of reinfection from relapse in recurrent Lyme disease. N Engl J Med. 2012;367(20):1883-1890. doi:10.1056/NEJMoa1114362

3. Krause PJ, Foley DT, Burke GS, et al. Reinfection and relapse in early Lyme disease. Am J Trop Med Hyg. 2006;75(6):1090-1094.

4. Tickborne Diseases of the United States. Centers for Disease Control and Prevention. https://www.cdc.gov/ticks/tickbornediseases/tickID.html. Accessed August 11, 2020.

5. How ticks spread disease. Centers for Disease Control and Prevention. https://www.cdc.gov/ticks/life_cycle_and_hosts.html. Accessed August 11, 2020.

6. Regions where ticks live. Centers for Disease Control and Prevention. https://www.cdc.gov/ticks/geographic_distribution.html. Accessed August 11, 2020.

7. Avoiding Ticks. Centers for Disease Control and Prevention. https://www.cdc.gov/ticks/avoid/index.html. Accessed August 11, 2020.

8. Be Tick aware Tick biteprevention program. Global Lyme Alliance. https://globallymealliance.org/education-awareness/be-tick-aware/. Accessed August 11, 2020.

9. Tick Removal. Centers for Disease Control and Prevention. https://www.cdc.gov/ticks/removing_a_tick.html. Accessed August 11, 2020.