Sex, Menopausal Status Tied to Severity of Early Lyme Disease Presentation

TUESDAY, March 3, 2026 (HealthDay News) — Sex and menopausal status appear to impact serologic status and severity of early Lyme disease, according to a study published online Feb. 7 in Clinical and Experimental Medicine.

Alison W. Rebman, M.P.H., from the Johns Hopkins University School of Medicine in Baltimore, and colleagues examined the clinical and serologic presentation of patients with early Lyme disease by sex and by menopausal status. The analysis included 243 adult, antibiotic-naive patients with a diagnostic erythema migrans rash present.

The researchers found that when adjusting for age, Lyme disease duration, systemic steroid use, and comorbid thyroid disease, men had higher odds of testing two-tier positive (odds ratio [OR], 1.77). This difference was even more pronounced when comparing men to premenopausal women (OR, 2.93). There were no significant differences found when comparing men with postmenopausal women. When adjusting for age and Lyme disease duration, men had higher odds of being in a higher disease severity score category (OR, 1.94), especially when compared with premenopausal women (OR, 2.26). There was a trend toward higher occurrence of heart palpitations, vomiting, and photophobia among women, while sleep difficulty was higher among men.

“In the immediate acute and convalescent period, males in our study had a clinical and laboratory presentation with more apparent objective abnormalities, and we hypothesize this could be due to differences in early host-pathogen interaction,” the authors write.

One author disclosed ties to the pharmaceutical industry and has a patent pending for Gene-Expression-Based Identification of Early Lyme Disease.

Abstract/Full Text