Healthcare Providers

New! Lyme Disease Prophylaxis After Tick Bite

Note: In general, CDC does not recommend antibiotics after tick bites to prevent tickborne diseases. However, in certain circumstances, a single dose of doxycycline after a tick bite in an area where Lyme disease is common may lower risk of Lyme disease.

New! Lyme Disease Serologic Testing and Pretest Probability

A patient’s pretest probability for Lyme disease helps inform whether they should be tested for Lyme disease.

New! Evaluation of Pediatric Knee Monoarthritis in Areas Where Lyme Disease Occurs

Note: This tool is intended to support healthcare providers. Providers should use clinical judgement, taking into account the patient’s history, diagnostic testing, and prior treatment when making clinical decisions for their patients.

Special thanks to Pedi Lyme Net and Dr. Lise Nigrovic for their research and input on the flow chart.

APHL Guidance and Interpretation of Lyme Disease Serologic Test Results

This report describes the proper interpretation of serologic testing for B. burgdorferi and identifies best practices for reporting results to clinicians, public health agencies, and patients.

Continuing Education

Lyme Disease Training Modules

This four-part series will enable front-line healthcare providers to recognize, diagnose, and treat Lyme disease, an increasingly common tickborne illness. The free online curriculum serves as a valuable resource for primary care clinicians, public health professionals, pharmacists, and health educators who encounter patients with Lyme disease. Free Continuing Education credits are available.

Module 1: Introduction to Tickborne Diseases and Disease Prevention (WB4328R)

This module highlights the following topics

  • Lyme disease transmission
  • Lyme disease geographic distribution
  • Care of a patient presenting with a tick bite
  • Appropriate use of post-exposure prophylaxis for Lyme disease following tick bite
  • Patient education about tick bite prevention
Module 2: Lyme Disease Clinical Overview (WB4329R)

This module highlights the following topics

  • Early localized and disseminated manifestations
  • Differentiating erythema migrans from other similar skin conditions
  • Recognizing clinical presentations that might suggest tickborne disease co-infections
Module 3: Lyme Disease Testing and Diagnosis (WB4330R)

This module highlights the following topics

  • How to select validated tests
  • Why there is currently no “test of cure”
  • How pretest probability and disease stage inform whether to test for Lyme disease
  • The significance of the seroconversion window period
  • Why testing for Lyme disease may not be clinically helpful for patients with erythema migrans
Module 4: Lyme Disease Treatment and Management (WB4380R)

This module highlights the following topics

  • Treatment options for erythema migrans
  • Clinical management of Lyme carditis
  • Clinical management of Lyme arthritis
  • Clinical management of neurologic Lyme disease
  • Care of patients with persistent symptoms attributed to Lyme disease

Clinician Outreach and Communication Activity (COCA) Webinar

This webinar provides healthcare providers and their patients with updated information in Lyme disease epidemiology, diagnosis, treatment, and prevention. The webinar also provides new educational tools that will be valuable to both healthcare providers and their patients in the prevention, diagnosis, and treatment of Lyme disease.

Lyme Disease Updates and New Educational Tools for Clinicians (WC2922-052021)

This COCA Call highlights the following topics

  • Populations at risk
  • Early signs and symptoms
  • Appropriate use of diagnostic tests
  • Appropriate use of antibiotics
  • Clinician and patient education on early signs and symptoms of Lyme disease, tick bite prevention and post-exposure prophylaxis


Additional Reading


Halperin JJ, Baker P, Wormser GP. Common misconceptions about Lyme disease. Am J Med 2013;126(3):264.

Hu LT. Lyme disease. Ann Intern Med. 2016 May 3;164(9).

Kugeler KJ, Schwartz AM, Delorey MJ, et al. Estimating the frequency of Lyme disease diagnoses, United States, 2010-2018. Emerg Infect Dis. 2021 Feb;27(2):616-619.

Schwartz AM, Kugeler KJ, Nelson CA, et al. Use of commercial claims data for evaluating trends in Lyme disease diagnoses, United States, 2010-2018. Emerg Infect Dis. 2021;27(2):499-507.

Stanek G, Wormser GP, Gray J, Strle F. Lyme borreliosis. Lancet 2012;379(9814):461-73.

Lyme Carditis

Marx GE, Leikauskas J, Lindstrom K, et al. Fatal Lyme Carditis in New England: Two Case Reports  Annals of Internal Medicine 2020;172(3): 222-224.

Forrester JD, Mead P. Third-degree heart block associated with lyme carditis: Review of published cases. Clin Infect Dis 2014 May 30. pii: ciu411.

Lyme disease post-exposure prophylaxis after tick bite

Nadelman RB, et al. Prophylaxis with single-dose doxycycline for the prevention of Lyme disease after an Ixodes scapularis tick bite. N Engl J Med. 2001 Jul 12;345(2):79-84.

Harms MG, et al. A single dose of doxycycline after an Ixodes ricinus tick bite to prevent Lyme borreliosis: An open-label randomized controlled trial. J Infect. 2021 Jan;82(1):98-104.

Pediatrics and Pregnancy

American Academy of Pediatrics. Lyme disease (Lyme borreliosis, Borrelia burgdorferi infection). In: Pickering LK, Red Book: 2021.

Grant DS, Neville DN, Levas M, et al. Validation of septic knee monoarthritis prediction rule in a Lyme disease endemic area. Pediatr Emerg Care. 2021 May 13.

Sood SK. Lyme disease in children. Infect Dis Clin North Am. 2015 Jun;29(2):281-94.

Waddell LA, Greig J, Lindsay LR, et al. A systematic review on the impact of gestational Lyme disease in humans on the fetus and newborn. PLoS One. 2018 Nov 12;13(11):e0207067.


Aguero-Rosenfeld ME, Wang G, Schwartz I, Wormser GP. Diagnosis of Lyme borreliosis. Clin Microbiol Rev 2005 Jul;18(3):484-509.

Association of Public Health Laboratories. Suggested reporting language, interpretation and guidance regarding Lyme disease serologic test results. [PDF – 17 pages] 2021.

Branda JA, Steere AC. Laboratory diagnosis of Lyme Borreliosis. Clin Microbiol Rev. 2021 Jan 27;34(2):e00018-19.

Branda JA, Strle F, Strle K, Sikand N, Ferraro MJ, Steere AC. Performance of United States serologic assays in the diagnosis of Lyme borreliosis acquired in Europe. Clin Infect Dis 2013 Aug;57(3):333-40.

Concerns regarding a new culture method for Borrelia burgdorferi not approved for the diagnosis of Lyme disease. MMWR 2014;63:333.

Hinckley AF, Connally NP, Meek JI, et al. Lyme disease testing by large commercial laboratories in the United States. Clin Infect Dis 2014 May 30. pii: ciu397.

Johnson BJ, Pilgard MA, Russell TM. Assessment of new culture method for detection of Borrelia species from serum of Lyme disease patients. J Clin Microbiol 2014;52:721–4.

Johnson, B.J. “Chapter 4: Laboratory diagnostic testing for Borrelia burgdorferi infection” in Lyme disease: An Evidence-based Approach, J.J. Halperin, Ed. (CAB International, 2011). Complete Article Reproduced with Permission. [PDF – 16 pages]

Mead P, Petersen J, Hinckley A. Updated CDC recommendation for serologic diagnosis of Lyme disease. MMWR Morb Mortal Wkly Rep. 2019 Aug 16;68(32):703.

Moore A, Nelson C, Molins C, et al. Current guidelines, common clinical pitfalls, and future directions for laboratory diagnosis of Lyme disease, United StatesEmerg Infect Dis. 2016 Jul;22(7).

Notice to readers: caution regarding testing for Lyme disease. MMWR, CDC Surveillance Summary 2005;54:125.

Recommendations for test performance and interpretation from the second national conference on serologic diagnosis of Lyme disease. MMWR 1995;44:590–591.

Mead PM, Petersen JM, Hinckley AF. Updated CDC recommendation for serologic diagnosis of Lyme disease. MMWR Morb Mortal Wkly Rep. 2019 Aug 16;68(32):703.

Swanson SJ, Neitzel D, Reed KD, Belongia EA. Coinfections acquired from Ixodes ticks. Clin Microbiol Rev 2006 Oct;19(4):708-27.

Ongoing Research Studies of Lyme disease / “Borrelia Infections”.

Biomedical Literature
Search the biomedical literature at PubMed.