Gender bias is now a widely recognized problem in research. Sometimes this happens because women haven’t been studied in the first place. Even when they have been included in the research, their results may not be analyzed separately from those of men. Because of this, we don’t know much about how women differ from men in how they contract a disease, are diagnosed, or respond to treatment.

Is this an issue in Lyme disease? Are women more likely to get Lyme disease, more difficult to diagnose, or more prone to treatment failure? We decided to launch a research study using data from the MyLymeData patient registry. To kick off the study, we asked Dr. Raphael Stricker to explain how males and females with Lyme disease might differ. His video presentation is included below.

Lyme Disease Gender Differences

Dr. Stricker identified four major areas in Lyme disease where males and females are not alike:

  • Women may attract more ticks and have more atypical Lyme rashes than men (Josek 2019).
  • Commercial two-tier Lyme testing favors men over women, because men have more positive ELISA tests and more positive Western blots (Feder 1992, Rebman 2015, Schwarzwalder 2010).
  • Women have an exaggerated response to Borrelia infection, with more inflammatory and inhibitory cytokines than men. This may promote the evolution of chronic Lyme disease. (Jarefors 2006).
  • Women may have a higher treatment failure rate.

Lyme Tests Are Biased To Detect More Males

The CDC Western blot criteria requires that 5 of 10 bands react for a lab test to be considered positive. A study by Feder, showed that men tend to have 6 positive bands, while women have only 4 positive bands. These women will not test positive for Lyme disease or receive the timely diagnosis and treatment needed to get well (Stricker, Johnson 2009).

Lyme Disease Prevalence — Almost Twice As Many Females As Males

According to the CDC, most reported surveillance cases are male—58% males vs 42% females. The CDC statistics also show a bimodal distribution of Lyme disease — with children and adults over 50 reporting the most cases. Both of these assumptions have recently been called into question by other big data studies.

For example, FAIR Health, one of the largest insurance claims data bases, recently released a report on Lyme disease that shows more insurance claim lines with Lyme disease diagnoses were submitted for females than males and females do not have a bimodal age distribution. In fact, between the ages of 23-50, there were almost twice as many females as males with Lyme disease. (FAIR Health 2019).

Lyme Disease Prevalence - for some ages (23-50), there were almost twice as many females as males with Lyme disease