Lyme & Tick-Borne Illness
What Is Tick-Borne Illness?
Tick-borne disease (TBD) is a term that refers to the wide range of infectious pathogens — including bacteria, viruses, fungi, protozoa, and parasites — that can be transmitted through the bite of a tick. These infections are often called “co-infections” because more than one pathogen may be passed on during a single bite.
Lyme disease (borreliosis) is the most well-known TBD. In the United States, it is primarily caused by Borrelia burgdorferi. In Europe, other species such as B. afzellii and B. garinii are more common.
Lyme disease has been called “the second great imitator” (after syphilis) because it can mimic so many other conditions. Like syphilis, it is a slow-growing spirochete bacterium. Unlike syphilis, however, it has the largest genome of any bacteria and is remarkably skilled at evading the immune system. It can also reactivate dormant infections such as Epstein-Barr virus or mycoplasma — microbes usually harmless in healthy individuals but problematic when the immune system is compromised.
Treatment Considerations
Treatment for tick-borne disease depends on whether the infection is acute (early) or chronic (persistent/longstanding).
Acute TBD:
Not all tick bites require antibiotics, but every bite requires careful assessment to evaluate possible pathogen transmission. Immediate treatment is often recommended for individuals who have:A history of Lyme disease
Symptoms consistent with transmission (with or without the classic EM rash)
A compromised immune system
Options may include pharmaceutical antibiotics, botanical antimicrobials, or immune-supportive therapies. Often, a combined approach is most effective.
Chronic TBD:
Chronic or complex cases require a deeper functional medicine assessment. Some individuals may be genetically or epigenetically predisposed to persistent Lyme disease. Treatment often involves addressing not just the infection but also underlying conditions (immune dysfunction, hormonal imbalance, environmental exposures, etc.). Here, an integrative, multi-systems approach is ideal.
Clinical Guidance
ILADS (International Lyme and Associated Diseases Society) provides evidence-informed, clinician-led guidance for diagnosing and treating Lyme disease. This allows providers to care for patients without bureaucratic restrictions, focusing instead on individualized and comprehensive treatment.
Controversy in the Diagnosis of Lyme Disease
One of the most challenging aspects of tick-borne illness is the lack of agreement within the medical community. The two leading voices — the Infectious Disease Society of America (IDSA) and the Centers for Disease Control and Prevention (CDC) on one side, and the International Lyme and Associated Diseases Society (ILADS) on the other — hold fundamentally different views.
They disagree on:
What Lyme disease is
How it presents
Which testing methods are reliable
What criteria should be used for diagnosis
How long and in what manner it should be treated
Importantly, the IDSA does not widely recognize the term “Chronic Lyme disease,” while ILADS acknowledges and treats it. This divide has slowed research, limited funding, and left many patients suffering long-term symptoms without appropriate care.
The Complexity of Tick-Borne Illness
Lyme and other tick-borne infections rarely present in the same way for every patient. The borrelia spirochete is an intelligent, adaptive organism. After entering the body, it “reads” the immune system it has invaded and manipulates it — overstimulating some responses while suppressing others. Over time, it becomes increasingly difficult to separate what symptoms are human-driven and what is pathogen-driven.
This means treatment must be highly individualized. What works well for one patient may be ineffective for another.
Diagnosis: A Clinical Process
Tick-borne illness is ultimately a clinical diagnosis. Listening for patterns of symptoms is essential.
Laboratory testing may support the diagnosis but is often unreliable due to high rates of false negatives.
Antibody tests can miss infections, especially in patients with immune suppression caused by the pathogens themselves.
Delays in diagnosis, misdiagnosis, and incomplete treatment are unfortunately common.
For this reason, we often use multiple labs to gather supportive data — including IGeneX and Tlabs— while relying heavily on clinical judgment.
Lyme Disease Testing
Currently, no objective test exists to confirm cure or eradication of Lyme disease.
There are over 300 strains of Borrelia burgdorferi worldwide, and at least 100 in the U.S.
False negatives are far more common than false positives. Some studies suggest up to 50% of patients tested receive false negative results.
Early-stage Lyme is especially hard to confirm, as the hallmark rash is not always present and tests often fail to detect infection in its earliest stages.
Because of this, the CDC itself emphasizes that clinicians must rely on clinical diagnosis — looking at symptoms, history, and exposure risks. Providers experienced in Lyme disease will treat when symptoms are consistent, even without a positive test, to prevent progression to chronic illness.
Stages of Lyme Disease
Lyme disease generally progresses through three stages:
Acute Lyme disease – earliest stage after infection
Early disseminated disease – infection begins spreading through the body
Chronic Lyme disease – longstanding, complex illness with systemic involvement
The earlier treatment begins, the better the outcomes. Infections that are under-treated often resurface, usually as chronic Lyme, leading to greater disability, harder diagnosis, and significantly higher cost of care.
Defining Chronic Lyme Disease
According to ILADS clinical guidelines, three criteria must be present to diagnose chronic Lyme disease:
Illness lasting for at least one year, corresponding to significant immune breakdown
Persistent neurologic involvement (encephalitis, encephalopathy, meningitis, etc.) or ongoing arthritic manifestations (such as active synovitis)
Evidence of active infection with Borrelia burgdorferi, regardless of whether prior antibiotic therapy was given