Professor Karina Butler:

If early Lyme disease is not treated, there is a definite risk of the development of late complications. In general, such complications manifest as arthritis, cardiac involvement or a variety of neurological and other symptoms. There is no doubt that that exists. The likelihood of antibody tests being positive increases significantly over time such that, for example, 97% of persons with arthritis as a result of Lyme disease will strongly test positive for Lyme disease. My colleague, Dr. De Gascun of the National Virus Reference Laboratory, may wish to contribute on that point. A US task force submission indicates that patients whose early Lyme disease was not diagnosed and who had very significant resultant chronic symptoms such as cardiac or other problems tested strongly positive in the standard two-step testing.

There is no doubt that a minority of persons diagnosed with and treated for Lyme disease will experience persistence of symptoms, but there is no evidence that that represents persistent infection. In fact, randomised control studies have examined whether re-treatment with prolonged antibiotic therapies or adopting a holistic approach with other treatments would make any difference for such patients. Although some patients got better, the proportion to do so was the same among those who received the treatment strategy as among those who did not. In other studies, patients with Lyme disease were shown not to have benefited from prolonged courses of antibiotics.