If you have the rash, that is the diagnosis. Blood tests are often negative early, and private overseas tests are not reliable.
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Lyme disease is a bacterial infection passed to people by infected ticks. In the UK it is most often picked up in grassy or wooded areas, and it is commoner than many people assume — the New Forest, parts of Scotland, Exmoor, the South Downs and Thetford Forest are recognised areas, though ticks are widespread.
The single most important thing on this page: if you have the characteristic expanding rash, that is the diagnosis. Treatment should start immediately and should not wait for a blood test.
This matters because blood tests are frequently negative in the first few weeks — they detect your antibody response, which takes time to develop. Waiting for a test to turn positive before treating is a well-recognised way of delaying treatment in someone who obviously has the infection.
Treated early, Lyme disease resolves completely in the great majority of people. Treated late, or not at all, it can cause joint, nerve and heart problems that are harder to reverse — which is the whole argument for acting on the rash.
Present in around two thirds to three quarters of people, and diagnostic on its own.
Fever, headache, muscle and joint aches, fatigue, swollen glands — an illness that feels like flu without the respiratory symptoms.
The rash is considerably harder to see and is missed more often. It may look brown, purple or simply darker than surrounding skin rather than red. Look for the expanding shape and the size, not for redness.
Lyme disease is not passed from person to person. Not by touch, not sexually, and not through blood donation in the UK.
Most tick bites do not cause Lyme disease. Only a minority of UK ticks carry the bacteria, and prompt removal reduces the risk further.
Erythema migrans is diagnostic clinically. No test is required, and treatment should not be delayed to obtain one. This is stated explicitly in national guidance and it is the point most often got wrong.
Where there is no rash but Lyme is suspected, testing is a two-stage process: an initial ELISA, and if that is positive or equivocal, a confirmatory immunoblot.
The critical limitation: these tests detect your antibody response, which takes weeks to develop. A test taken in the first few weeks can be negative in someone who genuinely has the infection. Where suspicion remains, the test is repeated four to six weeks later.
Equally, antibodies persist long after successful treatment. A positive test does not mean ongoing infection, and repeat testing to check whether treatment has worked is not useful.
A number of laboratories, mostly outside the UK, sell Lyme tests that are not validated and produce a high rate of false positives. These include lymphocyte transformation tests, certain urine antigen tests and some non-standard immunoblots.
People who receive those results are frequently told they have chronic Lyme disease and offered months or years of antibiotics. That treatment is not supported by evidence, and prolonged intravenous antibiotics in particular cause real harm — line infections, C. difficile and organ toxicity have all been documented.
None of that means the symptoms are imagined. People in this situation are genuinely unwell and are often poorly served by everyone involved. But the answer is a proper diagnostic reassessment, not an unvalidated test and an indefinite antibiotic course.
Cellulitis (hot, painful, spreading fast), ringworm (scaly, itchy), an insect bite reaction, granuloma annulare, and for the later features — rheumatoid arthritis, multiple sclerosis, fibromyalgia and chronic fatigue syndrome.
Lyme disease assesses well remotely when there is a rash, because a good photograph plus a history of possible tick exposure is genuinely enough to diagnose and treat. See our guide to photographing a skin problem, and photograph it with something for scale.
Any neurological, cardiac or joint involvement needs specialist input. Facial weakness, palpitations, blackouts or a swollen joint are assessed in secondary care, not managed on a video call.
Seek emergency care for:
Seek prompt assessment for:
A small itchy red bump appearing within hours and settling over a day or two is a normal reaction to being bitten. It is not Lyme disease.
A patch appearing days to weeks later, expanding steadily, and neither itchy nor sore — that is the one to act on.
Do not burn it, smother it in petroleum jelly, cover it in alcohol, or squeeze the body. All of these can make the tick regurgitate into the wound, which increases rather than reduces the risk. This is folk advice that persists and is actively counterproductive.
If mouthparts remain in the skin, leave them. They cause no more than a minor local reaction and work their way out. Digging for them does more harm.
Preventive antibiotics after a UK tick bite are not routinely recommended. The great majority of bites do not transmit infection.
Watch the site for six weeks. If a patch appears and expands, get it seen — and photograph it with something for scale, since it may be treated on that photograph.
The NHS testing pathway is the one to use. That is not institutional loyalty — UKHSA reference laboratory testing is validated, and much of what is sold privately is not.
Unvalidated Lyme panels, or long-term antibiotics for chronic Lyme disease. Neither is supported by evidence, and the second causes documented harm. If your symptoms are real and unexplained — and they may well be both — the honest route is a proper reassessment of what else could be causing them.
This page follows NICE NG95 on Lyme disease, alongside UKHSA guidance on tick awareness and laboratory testing.
UKHSA advises removing ticks with fine-tipped tweezers or a removal tool, pulling steadily upward without crushing the body, and explicitly advises against burning or smothering.
Tests offered by some laboratories outside standard validated pathways have been found to produce high rates of false-positive results, and NICE cautions against making a diagnosis on them or providing prolonged antimicrobial treatment on that basis.
Reviewed against NICE NG95 and UKHSA guidance current at the date shown above.
No — and waiting for one is the commonest mistake. The rash is diagnostic on its own and treatment should start immediately.
Early blood tests are frequently negative because antibodies take weeks to develop.
Not in the first few weeks. If suspicion is high, the test is repeated four to six weeks later.
Antibodies take time. A negative test early in the illness is a timing problem, not an answer.
Not routinely in the UK. Most bites do not transmit infection.
Watch the site for six weeks and act if an expanding patch appears.
No. Many are uniformly discoloured with no central clearing.
What matters is that it expands over days and is neither itchy nor painful — not whether it has rings.
Fine-tipped tweezers, grasp close to the skin, pull steadily upward. No twisting.
Never burn it or smother it in Vaseline — that can make it regurgitate into the wound and increases the risk.
Leave it. Remaining mouthparts cause only a minor local reaction and work their own way out.
Digging for them causes more damage than they do.
Some people have genuinely persistent symptoms after treated Lyme disease, and that is recognised. What is not supported is diagnosing it on unvalidated tests, or treating it with months of antibiotics.
Prolonged intravenous antibiotics cause documented harm and have not been shown to help. Persistent symptoms deserve a proper reassessment, not an indefinite course.
No. Several produce high rates of false positives and are not validated.
Use UKHSA reference laboratory testing, which is available on the NHS and is the testing the guidance is built on.
Not from a person — it is not contagious.
Not directly from a dog either, though dogs bring ticks into the house, so check them after walks.
August 30, 2026
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It means the diagnosis can usually be made from your history and photographs, and that treatment can be arranged safely without examining you. Where a condition is not marked treatable online, it is because examination is the diagnosis — listening to a chest, feeling an abdomen, examining an ear or a joint — or because a procedure or device is needed.
Yes, where there is a genuine bacterial infection — cellulitis, impetigo, bacterial urine infections, confirmed strep throat. We will also frequently tell you that you do not need one. Most sore throats, coughs, colds and earaches are viral, and an antibiotic gives you the side effects with none of the benefit.
If your problem turns out to be genuinely outside what we can do remotely, the doctor will tell you straight away, point you to the right service, and refund your fee in full. We would rather do that than fill twenty minutes to justify the charge.
Call 999 or go to A&E — do not book an online appointment and do not wait for a reply to an email. For urgent problems that are not emergencies, NHS 111 is available 24 hours a day, online or by phone, and can direct you to the right service.
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