The duration of treatment for Lyme disease has been a contentious issue among physicians. The fact that two major medical associations - the Infectious Diseases Society of America (IDSA) and the International Lyme and Associated Diseases Society (ILADS) - have released conflicting guidelines for the diagnosis and treatment of Lyme disease has fueled the controversy.

"Publication of our recommendations about the most effective treatment for Lyme disease in a journal like CID is a milestone for ILADS," said Dr. Raphael Stricker, president of ILADS. "Doctors, patients and insurance companies need to know that the IDSA guidelines are flawed."

Difficult to Diagnose
A primary factor in the Lyme disease controversy is that the disease can be difficult to diagnose. Not every patient suffers from the typical "bull's-eye" rash and joint inflammation, considered classic symptoms of Lyme disease that is transmitted by the bite of a tiny tick.    ILADS research indicates that only 50%-60% of patients typically recall a tick bite; the rash is reported in only 35% to 60% of patients; and joint swelling typically occurs in only 20% to 30% of patients. And given the prevalence of over-the-counter anti-inflammatory medication such as Ibuprofen, the joint inflammation is often masked.

Many patients with Lyme disease will continue to experience a variety of symptoms, even after the treatment recommended by IDSA. Some of these patients go on to develop multiple nonspecific symptoms, making it very difficult to diagnose chronic Lyme disease.

One reason for this difficulty is that Borrelia burgdorferi, the corkscrew-shaped bacteria that causes the disease, has an unusual genetic makeup. This allows the bacteria to screw its way into a variety of cells and evade the body's immune system. According to ILADS research, the Lyme bacteria invades multiple tissues and is able to assume a dormant state much like tuberculosis. This can make treatment much more difficult.

Extended Therapy
Based on extensive clinical evidence, ILADS maintains that extended antibiotic therapy for Lyme disease is sometimes necessary, particularly in later disease that is more difficult to eradicate. Studies have shown that Borrelia burgdorferi can persist after antibiotic treatment. In particular, studies conducted in animals - including mice, dogs and monkeys - indicate that the corkscrew-shaped bacteria can persist after treatment is completed. Persistence in humans has been confirmed by culture or molecular testing in at least a dozen studies.

"Science in this area is still evolving," according to Stricker. "We don't have all the answers and it is too early to adopt treatment strategies that assume we do. Meanwhile, doctors need flexible treatment approaches," he said.

The article describing the ILADS position on treatment of Lyme disease will be published in the July 15 issue of Clinical Infectious Diseases.

About ILADS
ILADS is a nonprofit, international, multidisciplinary medical society dedicated to the diagnosis and appropriate treatment of Lyme disease and associated tick-borne infections. ILADS promotes understanding of tick-borne diseases through research and education and strongly supports physicians and other health care professionals dedicated to advancing the standard of care for tick-borne diseases.