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).
Illness invalidation can occur when a patient feels that their medical condition is not being appropriately recognized.4 Research at our Center finds that illness invalidation is a common problem in Lyme disease. Patients with post treatment Lyme disease, particularly women and younger individuals, experience greater illness invalidation from medical professionals than older or male-gendered patients.5 This research indicates women are more likely to receive an alternative diagnosis for their persistent symptoms, which in turn is associated with more discounting and lack of understanding and delays in appropriate treatment. Patients who reported the highest levels of invalidation also have higher symptom severity, lower quality of life, and lower trust in physicians.
Due to these and other factors, women may be at a greater risk of delayed diagnosis and treatment of Lyme disease, which may increase their risk of developing Lyme infection-associated chronic illness.
Other factors being studied 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 timely clinical diagnoses and providing optimal patient care.
More research and education are needed.
References:
- 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/ ↩︎
- 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/ ↩︎
- 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/ ↩︎
- 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/ ↩︎
- Rebman, A.W., Yang, T. & Aucott, J.N. Invalidation by medical professionals in post-treatment Lyme disease. Sci Rep 14, 19406 (2024). https://doi.org/10.1038/s41598-024-70556-7 https://www.nature.com/articles/s41598-024-70556-7 ↩︎
