Justin Timberlake’s Lyme disease diagnosis explained: Know the symptoms and how to prevent it

Toward the latter half of Justin Timberlake’s “Forget Tomorrow World Tour,” the singer was met with a flood of criticism after videos of him giving a lackluster performance of “Can’t Stop the Feeling!” went viral on social media. Timberlake called on the audience to sing most of the song, only joining in for the occasional lyric. Many fans were furious, with some demanding refunds. However, the former NSYNC star later revealed that he wasn’t being lazy … he was battling Lyme disease.

“If you’ve experienced this disease or know someone who has—then you’re aware: living with this can be relentlessly debilitating, both mentally and physically,” says Timberlake in a statement posted to Instagram. “When I first got the diagnosis, I was shocked for sure. But at least I could understand why I would be onstage and in a massive amount of nerve pain or just feeling crazy fatigue and sickness.”

Timberlake joins the likes of Shania Twain, Avril Lavigne, Justin Bieber and other artists who have been candid over the years about their diagnosis of Lyme disease—a bacterial illness that’s transmitted via a tick bite. According to the CDC, almost 90,000 cases of Lyme disease are reported annually, though some cases may go undiagnosed or misdiagnosed.

Gul Madison, MD, a Trinity Health Mid-Atlantic Medical Group infectious disease specialist at Infectious Disease Darby, explains why it’s so important to know the signs of Lyme, when to get help and ways to protect yourself from a tick bite, especially in endemic areas like the Philadelphia suburbs and Bucks County.

Be aware of Lyme disease symptoms

Within days or weeks after a tick bite, most individuals with Lyme disease will feel flu-like symptoms, including headache, muscle and joint pain and/or fever, in addition to a skin lesion at the site of the bite.

“It is typically a round lesion, sometimes with central clearing. It can look like a target lesion, but it’s not always like that. Sometimes there is no central clearing, so you can see completely red lesions as well,” says Dr. Madison. “And other times, you don’t see any skin lesions. You may just have symptoms of Lyme disease without the skin lesions.”

If Lyme remains untreated, it can cause further complications within weeks or months. These may include cardiac issues like heart block (which can result in a pacemaker in more serious cases) and neurological problems, such as facial nerve pulsing, meningitis or radicular nerve manifestations.

“If it is still not treated at this stage, then you can have late manifestations of the disease, which is very difficult to diagnose at that time because this is months after the tick bite. Typically, patients are not even thinking about tick bites,” says Dr. Madison. “They may develop arthritis and other joint-related issues.”

Lyme disease transmission and treatment

Lyme is transmitted by ticks that carry a bacteria called Borrelia burgdorferi. Usually, these dangerous ticks are in the nymph stage of life and are no bigger than a poppy seed, making them extremely difficult to see when they attach to the body. Nymphs typically look for a blood meal during the spring and summer, coinciding with the time of year that more folks are partaking in outdoor activities.

“When the tick attaches to the body, the bacteria is not transmitted immediately. It takes hours because the bacteria lives in the midgut of the tick. When the tick attaches to the skin, it travels very slowly from the midgut to the saliva of the tick, and from the saliva to the skin. This takes at least 36 hours,” explains Dr. Madison. “So if there is a tick that has attached to the skin for 36 hours or more, then that is a risk for Lyme disease. At that point, a single dose of the antibiotic doxycycline, 200 milligrams, can be given to the person and that can prevent Lyme disease development.”

This means that getting bit by a bacteria-carrying tick doesn’t always result in a Lyme diagnosis. For example, if you notice a tick on your body and know that it latched on during the hike you took only 30 minutes prior, it won’t transmit Lyme as long as you’re able to remove it before that 36-hour mark. Fine-tip tweezers can be used, but Dr. Madison warns that this process is easier said than done.

“If you’re not able to remove it, never, ever crush the tick. Go to a health care facility and have someone experienced with this remove the entire tick with the legs and all. If the particles of the tick remain in the skin, it can still transmit Lyme disease,” she says.

Ways to prevent Lyme disease

Since ticks are so tiny, it’s often difficult to know that one is attached to your body, especially if it’s on the back and not in immediate eyesight. In fact, their saliva has a chemical that numbs the skin, making it nearly impossible to even feel the bite.

Dr. Madison recommends minimizing exposure by wearing long-sleeved, light-colored clothing, tucking your shirt into your pants and pants into your socks, and using EPA-approved tick repellent. If you’ve been out in nature, whether on a hike or just out in the backyard tending to the garden, examine your body upon returning indoors.

“If possible, have someone else take a look at your body because you can’t see your back. Typically, we’ll see these ticks attached to people’s shoulder blades, at the back of their knees, parts that we don’t necessarily see ourselves,” says Dr. Madison.

She also recommends taking a shower within two hours of coming back home and washing any clothes worn outside, followed by a cycle in the dryer on high heat.

Living with Lyme disease

A Lyme diagnosis isn’t always made in a timely manner. Infected individuals may not know they were bitten by a tick, assume their symptoms are caused by something else and delay getting help until those more serious conditions start manifesting. At Infectious Disease Darby, Dr. Madison can conduct a diagnostic serum test to determine if the root cause is Lyme. For patients with late-stage Lyme disease, some of those conditions may be long-lasting, even if antibiotics are administered.

“The arthritis, for example, is caused by the body’s immune reaction to the infection. So even after the bacteria is cleared from the body, the immune reaction continues for some patients. In that case, the symptoms may continue despite treatment,” says Dr. Madison. “They may also still have headaches, fatigue, joint pain, cognitive difficulty. This may last for a long time for certain patients. It’s generally not related to the bacteria itself, but the body’s reaction to the bacteria. So we help them manage those symptoms individually if it happens.”

Final thoughts

Whenever a celebrity like Timberlake is diagnosed with Lyme disease, they usually work to spread awareness about the condition, which Dr. Madison says is great for the public at large.

“There’s going to be Lyme every summer, every spring. It doesn’t have to be in a state park. You can get Lyme in your backyard,” she says. “We have to be aware of this. We have to know what it is. We have to know how to prevent it and recognize the symptoms because it becomes more challenging to diagnose if it’s not treated in a timely manner.”

Infectious Disease Darby accepts new patients, including anyone who needs to be evaluated for Lyme disease. Visit Infectious Disease Darby for more information and to make an appointment.