‘Congenital’ Lyme Disease Prevention and Prophylactic Antibiotics
Despite a lack of evidence, it is suggested by some that Lyme disease can be transmitted through sexual contact or during gestation, with the bacteria passing from mother to foetus. Although a small number of studies have shown evidence of Borrelial DNA in sperm it does not appear to be capable of causing infection through sexual contact. Animal studies have shown that the Lyme disease bacteria can cross the placenta during pregnancy and that infection shortly after conception may increase the risk of pregnancy complications and an adverse pregnancy outcome. However, there is little evidence to suggest that a human patient with an existing Lyme disease infection is at risk of passing on the infection to their child and official guidelines maintain that congenital Lyme disease simply does not exist. Clearly all those who are infected with Lyme disease should be treated with appropriate antibiotics which may be different during pregnancy so as to reduce possible side-effects for the growing foetus.
Prophylactic Anitbiotics and Fatal Infection in Pregnancy
It is also considered extremely unlikely for a breastfeeding infant to contract Lyme disease from their mother although, again, the antibiotics used to treat the mother should be appropriate so as to safeguard both infant and maternal health. Some Lyme disease advocates and self-anointed Lyme disease doctors have suggested that prophylactic antibiotic treatment should be given to women who are trying to conceive or during pregnancy to prevent infection and any chance of passing on the infection to a child. However, as the risks of gestational antibiotic treatment, such as serious candidiasis or infection with Clostridium difficile (which can be fatal) outweigh the likelihood of Lyme disease occurring, no specific Lyme disease prevention efforts are considered necessary during pregnancy or pre-conception.
Prophylactic Antibiotic Use for All Patients
The use of prophylactic antibiotic treatment in the general patient population is also considered inappropriate, although some doctors may prescribe antibiotics to a patient who lives in a Lyme endemic area and who has suffered a tick bite. This might be done where a large portion of the local ticks are known to be infected with Borrelia, whilst the physician waits for the results of Lyme disease tests such as an ELISA test or a tick test to detect Borrelial DNA. This would mean that a patient is less likely to develop symptoms of an infection or experience widespread, disseminated Lyme disease symptoms than if treatment is delayed until a positive ELISA and Western blot confirmation are established. However, in most areas it is not thought necessary or beneficial to start antibiotics for every patient, or pets such as dogs, who have been bitten by a tick. The possible risks of antibiotic treatment are usually considered to outweigh the risk of having become infected in such areas, and there are also concerns about creating antibiotic resistance.
Removing Ticks Promptly Prevents Most Lyme Infection
Early removal of a tick is usually sufficient to prevent infection occurring as the tick must be in place for at least twenty-four hours in most cases in order for the Lyme disease bacteria to move from the tick’s gut to its saliva and enter the human (or animal) host. Some strains of Lyme disease bacteria may, however, be present in the tick’s saliva even at the onset of a bite. This is the case with Borrelia afzelii in Ixodes persulcatus ticks found in Europe and Asia, which can mean that infection of the mammal host occurs faster than with Ixodes scapularis and Borrelia burgdorferi in the US. This has prompted some to call for increased prophylactic antibiotic use but the practice remains rare as the vast majority of ticks in Europe and Asia are not considered to be infected with Borrelia. Instead, the usual course of action is to wait and see if symptoms arise or a positive test result emerges before treating the patient, with antibiotics used for Lyme disease prevention only in very specific cases where infection would be extremely dangerous even in the short term.