Recurrent Lyme Disease: Old or New Infection?

Lakshmi Ganapathi, MBBS; Neeraj Surana, MD, PhD

Disclosures

October 21, 2013

Post-Lyme Syndrome

There is no evidence to suggest that patients who receive recommended courses of antibiotics for Lyme disease have any residual spirochetes remaining in their body.

Data demonstrate that -- after appropriate antibiotic therapy -- patients with recurrent Lyme disease had reinfection as opposed to relapsed disease,[2] which suggests that the standard recommended antibiotic courses are sufficient for complete eradication of B burgdorferi from the body. Although a small percentage of patients with Lyme disease who receive appropriate treatment continue to experience disabling, subjective symptoms, such as musculoskeletal pain, fatigue, and neurocognitive difficulties, there is no evidence to indicate that this post-Lyme syndrome results from active infection. One study that compared treating this patient population with antibiotics for 3 months (parenteral ceftriaxone for 1 month followed by oral doxycycline for 2 months) with placebo found no differences in symptomatology at the end of the study period.[7] As such, post-Lyme syndrome, which is often colloquially referred to as "chronic Lyme disease," does not involve persistent or recalcitrant B burgdorferi infection. Long-term antibiotics are not warranted in these patients. Instead, they should be screened for other diseases, such as chronic fatigue syndrome and fibromyalgia, and offered symptomatic relief rather than antibiotics.

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