Sex-and Gender-Based Differences in Lyme Disease

Research shows there are sex- and gender-based differences in Lyme disease, and these may impact the severity of and risk for Lyme disease associated persistent illness.

During acute Lyme disease, both men and women can exhibit flu-like symptoms such as fever, fatigue, and body aches and an erythema migrans rash (although the Lyme rash is not always recognizable or present).

Men and women experience differences in Lyme disease rash size, diagnostic blood test outcomes, and type and severity of symptoms.

Men present with a larger diameter Lyme disease rash, closer to an inch bigger than women.¹ Men have also been found to experience higher odds of having a CDC-positive two-tier diagnostic blood test.²

Alternatively, women have been found to experience higher severity of symptoms and misattribution of symptoms to psychosomatic, psychiatric conditions or other chronic illnesses.³

Women also exhibit more non-traditional symptoms at acute onset (such as nausea, heart palpitations, light sensitivity, tingling, vomiting).

Due to these and other factors, women may be at a greater risk of delayed diagnosis of Lyme disease.

It is possible that a longer time to diagnosis and treatment may increase a women’s risk of developing Lyme disease associated persistent illness.

Illness invalidation occurs when a patient feels that their medical condition is not being appropriately recognized.⁴ Illness invalidation can be common in Lyme disease, particularly for women, and can be a contributing factor to a delayed diagnosis. Current research at the Johns Hopkins Lyme Disease Research Center is investigating the sex- and gender-based associations of illness invalidation by medical professionals by evaluating symptom burden, quality of life, and general trust in health professionals. This research will identify clinical and demographic risk factors associated with more invalidating experiences.

Other factors being explored by the Johns Hopkins Lyme Disease Research Center include how men’s and women’s immune and hormonal systems (including menopausal status) might be influencing blood tests and immune outcomes.

An important takeaway for health practitioners and patients is that sex- and gender-based differences in Lyme disease do exist and understanding these differences may be important to making a timely clinical diagnosis and providing improved patient care.

More research and education are needed.

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References:

1. Rebman AW, Yang T, Mihm EA, Novak CB, Yoon I, Powell D, Geller SA, Aucott JN. The presenting characteristics of erythema migrans vary by age, sex, duration, and body location. Infection. 2021 Aug;49(4):685-692. doi: 10.1007/s15010-021-01590-0. Epub 2021 Mar 7. PMID: 33682067. https://pubmed.ncbi.nlm.nih.gov/33682067/ ↩︎
2. Schwarzwalder A, Schneider MF, Lydecker A, Aucott JN. Sex differences in the clinical and serologic presentation of early Lyme disease: Results from a retrospective review. Gend Med. 2010 Aug;7(4):320-9. doi: 10.1016/j.genm.2010.08.002. PMID: 20869632. https://pubmed.ncbi.nlm.nih.gov/20869632/ ↩︎
3. Johnson L, Shapiro M, Janicki S, Mankoff J, Stricker RB. Does Biological Sex Matter in Lyme Disease? The Need for Sex-Disaggregated Data in Persistent Illness. Int J Gen Med. 2023 Jun 17;16:2557-2571. doi: 10.2147/IJGM.S406466. PMID: 37351009; PMCID: PMC10284166. https://pubmed.ncbi.nlm.nih.gov/37351009/ ↩︎
4. Rebman AW, Aucott JN, Weinstein ER, Bechtold KT, Smith KC, Leonard L. Living in Limbo: Contested Narratives of Patients With Chronic Symptoms Following Lyme Disease. Qual Health Res. 2017 Mar;27(4):534-546. doi: 10.1177/1049732315619380. Epub 2016 Jul 10. PMID: 26631681. https://pubmed.ncbi.nlm.nih.gov/26631681/ ↩︎