Lyme disease

Lyme disease is an infectious disease caused by bacteria. It can be transmitted by ticks. In Germany, about 3 out of 10,000 people develop Lyme disease each year.

At a glance

  • Lyme disease is an infectious disease caused by bacteria.
  • It can be transferred to humans by tick bites.
  • This infection is less likely if the tick is removed in time.
  • Lyme disease can cause a rash with a ring-like appearance on the skin around the bite or flu-like symptoms.
  • It is usually treated with antibiotics. 
  • In Germany, about 3 out of 10,000 people develop Lyme disease each year.

Note: The information in this article cannot and should not replace a medical consultation and must not be used for self-diagnosis or treatment.

Lyme disease: leg with red ring or expanding rash (erythema migrans) following a tick bite.

What is Lyme disease?

Anyone who spends a lot of time in the countryside can expect to get bitten by a tick at some point. Some ticks transmit diseases such as Lyme disease. Lyme disease is an infectious disease caused by bacteria.

The first sign of Lyme disease is inflamed skin near the bite. The bacteria that cause the infection – called Borrelia bacteria – might later go on to attack joints or various organs But the infection usually doesn't cause any serious problems.

What are the signs of Lyme disease?

The skin around a tick bite usually turns red and itches. This inflammatory reaction is normal and has nothing to do with Lyme disease. But if the skin near the bite is red a few days or weeks after the bite, it could be a sign of Lyme disease. A Lyme disease rash typically spreads outwards with a ring-like appearance until it reaches a diameter of more than five centimeters. This rash is called erythema migrans (Latin for "migrating redness").

A red ring on the skin around a bite may be an indication for Lyme disease.

Flu-like symptoms such as fever, headache, drowsiness or aching muscles can also develop within six weeks of being bitten. These symptoms could also be signs of Lyme disease, even if there is no EM rash.

Flu symptoms appearing after one or two weeks may indicate tick-borne encephalitis (TBE), but that is rare.

Post-Lyme syndrome / “Chronic Lyme disease” – what does it mean?

Some people experience symptoms like achy muscles and joints, severe exhaustion or memory problems months or even years after being bitten by a tick. Some of the people affected by these problems and some doctors believe that the symptoms are a delayed complication of a Borrelia bacteria infection. This group of symptoms is sometimes referred to as post-treatment Lyme disease syndrome or "chronic Lyme disease" – although the latter is not generally accepted as a diagnosis.

These symptoms are sometimes linked to Lyme disease even if the person wasn't known to have been bitten by a tick and the blood tests didn't show any evidence of infection. Then it is unlikely that the symptoms actually have anything to do with a Lyme disease infection. They may have been caused by any number of other medical conditions.

What causes Lyme disease?

Lyme disease is an infectious disease caused by bacteria. Some ticks transfer these bacteria to humans when they bite.

What increases the risk of getting Lyme disease?

The risk of a tick bite causing Lyme disease will mainly depend on

  • how long the tick was attached to the skin, and
  • how old and big it was.

Large ticks are more likely to be infected with Lyme disease than small ticks because they are older and will generally have fed on more host animals.

Borrelia bacteria are found in all parts of Germany, but the proportion of infected ticks varies greatly from region to region.

Even if someone is bitten by an infected tick, they will not necessarily get Lyme disease. The Borrelia bacteria live in the bowel of the tick. This means that the host will only become infected – if at all – after the tick has fed for quite a long time. That is why checking the body soon after spending time outdoors, and removing any ticks within 24 hours, is an effective way to prevent Lyme disease.

More detailed information on Lyme disease, for example, how to remove ticks, can be found at

How often does Lyme disease occur?

Around 3 out of every 10,000 people contract Lyme disease every year in Germany.

It is estimated that about 1 out of 100 people who are bitten by a tick develop Lyme disease. In Germany, about 3 out of 10,000 people develop it each year.

How can Lyme disease be prevented?

The risk of tick bites will depend among other things on the region and a person’s general behavior in nature. One way of protecting oneself is to wear closed shoes when in tall grass or bushes. Clothing which covers as large an area of the body as possible – for example long trousers and long-sleeved T-shirts – is also recommended. This makes it harder for ticks to attach themselves. Light clothing can also be a good idea as this helps to more easily identify ticks than on darker clothes.

Before ticks bite, they sometimes crawl around on the body for hours. Checking one’s body soon after spending time in the woods or in the garden, and removing any ticks, stops a bite from happening and reduces the risk to get Lyme disease. Children often forget to do this so it is important to remind them. Both children and adults should accept help with checking their bodies – especially in places which are difficult to check oneself.

Important: According to the Robert Koch Institute, tick sprays (repellents) can offer a certain amount of protection from ticks for about two to four hours. But then the effect wears off meaning these sprays have to be used repeatedly if staying outside for a longer period of time.

Anyone bitten by a tick should watch to see if any symptoms develop which indicate an infection. If there is indeed an infection, it is necessary to see a doctor.

How is Lyme disease diagnosed?

If a typical rash has developed, Lyme disease can be diagnosed just by looking at it. It is important to tell the doctor about the tick bite. If the physical examination is not sufficient, the blood may be tested for borrelia bacteria.

What are the signs of Lyme disease (borreliosis)?

The video below explains more about how you can become infected with Lyme disease as well as the symptoms and treatment options.

This and other videos can also be found on YouTube

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How is Lyme disease treated?

Lyme disease is treated with antibiotics. This medication is taken over a period of two to four weeks, depending on the symptoms. The disease then usually goes away without any complications. Sometimes, though, initial treatment with antibiotics isn't effective enough, and you might need to use different antibiotics.

The symptoms of Lyme disease may also get better by themselves without taking antibiotics, but then the disease is more likely to lead to more serious complications. If the bacteria spread within the body, the first symptom is a burning pain near the tick bite. About 3 out of 100 people then develop a disease called neuroborreliosis, in which the infection spreads to the brain and nerves. This can lead to paralysis (often affecting the face), painful nerve inflammations, or meningitis.

Another complication that can develop months or even years after someone is infected is called Lyme arthritis. This affects about 2 out of 100 people. Lyme arthritis arises if the infection spreads to the joints, causing painful inflammations and swelling. Very rare complications include heart problems and chronic inflammation of the skin. Both neuroborreliosis and Lyme arthritis can be treated effectively with antibiotics and usually don't have any long-term effects.

How can ticks be removed?

If a tick has attached itself to the skin, it's important to remove it as soon as possible. Special tools are available for removing ticks, including tick tweezers, tick-removal cards and hook-like instruments. These tools are shaped to make it easy to slide them between the tick and the skin without squeezing the tick. These kinds of aids are available in pharmacies, for example.

Normal tweezers can also be used, as long as the tips of the tweezers bend inwards. But if the tips are flat, the tick will be automatically squeezed when trying to get hold of it. This should generally be avoided, because then germs could be squeezed out of the tick and into the body.

Where can I find support?

Self-help groups offer people with Lyme disease and their relatives a way of obtaining information and advice, and sharing personal experiences.

You can find suitable self-help via a database on the National Contact and Information Point For Encouraging and Supporting Self-Help Groups (NAKOS) website.

In cooperation with the Institute for Quality and Efficiency in Health Care (Institut für Qualität und Wirtschaftlichkeit im Gesundheitswesen) (IQWiG). As at:

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