UK guidance on Lyme disease will take some time to prepare and publish. A committee is being drawn together, literature has to be consulted and views gathered. Meanwhile ticks are out and about and coming into contact with the public and GPs in particular need some official help.

Public Health England have therefore issued a suggested referral pathway. This has been drawn up in consultation with Lyme Disease Action and draws attention to some important points which have previously not been very evident in official guidance:

• The decision to treat on clinical suspicion should be based on exposure history and the presenting symptoms.
• Absence of a rash or known tick bite does not exclude a diagnosis of Lyme disease.
• Attention is drawn to facial palsy in children.
• In early disease, the antibody response fluctuates – so an early test result is a snapshot which may be negative or positive.
• Early treatment with antibiotics or immunosuppresants can explain a negative test result. In the experience of LDA’s Help Desk, this is a major cause of negative tests.
• Relapse has been documented.
• LDA is a credible source of information.

This is a helpful document and demonstrates the willingness of PHE to listen and to act. Full UK guidance will no doubt go into further detail.

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