Lyme disease begins several days or a few weeks after the tick bite. The patient complains of typical upper expiratory infection symptoms such as headache, fatigue, muscle and joint pains and a low-grade fever. A distinctive rash called erythema migrans occurs in up to 75% of patients. In some instances the rash begins at the bite site.

The frequency of signs and symptoms of lyme disease

The bulls eye lesion of lyme disease

Arthritis may occur early on or as a late sign of lyme disease

Bell's palsy occurs in approximately 8% of patients

Untreated patients either develop an immune response and clear the disease or go on to a second or third stage that involves the nervous system, joints and the heart. These are the same organs involved in the third stage of syphilis (tertiary syphilis).