Exploring gender difference among patients with chronic symptoms and medical histories suggestive of Lyme disease

Background: Lyme disease is an emerging infectious disease with both early and late manifestations. CDC surveillance shows similar incidence of Lyme disease across gender. While appropriate early intervention has been shown to influence disease course and presentation of late or chronic symptoms, the impact of gender on this relationship is not well understood.

Objective: To explore gender differences in clinical findings, prior antibiotic treatment and initial misdiagnosis among patients with chronic symptoms and evidence for prior exposure to Lyme disease.

Methods: A consecutive case series of adult patients presenting to a community-based Lyme referral practice in Maryland revealed 88 patients with chronic symptoms and a history of either positive serology or documented objective findings characteristic of Lyme disease. Patient histories were obtained through retrospective chart review and self-report.

Results: Female gender was associated with a 37% decreased risk of having a positive IgG result (RR = 0.63 [0.41-0.96], p=0.03) and women were 37% less likely to meet criteria for a defined late or chronic Lyme-related illness (RR= 0.63 [0.35-1.12], p=0.12). Prior antibiotic exposure was non-significant, however women were 1.79 times more likely to have been inappropriately prescribed steroids (RR= 1.79 [0.78-4.13], p=0.17). Initial physician (RR= 1.64 [0.70-3.85], p=0.25) and patient self-misdiagnosis (RR = 3.66 [0.81-16.7], p=0.09) were more common among women.

Discussion: Although small sample sizes preclude over-generalization, this exploratory analysis highlights possible gender differences in aspects of both appropriate initial intervention and late clinical manifestation. Further analyses to delineate the sociologic and/or biologic determinants of these differences are needed.