A blood test will detect it.

A blood test won’t always detect it.

It can be cleared up with antibiotics.

Antibiotics don’t always cure it.

Everyone already has it, but they don’t know it yet.

Everyone doesn’t have it, but it’s underreported.

Although Lyme disease was first diagnosed more than 30 years years ago, much about the illness remains a mystery. Claims are made and rumors are spread as people cope.

How is it diagnosed? What’s the best treatment? How long can Lyme linger?

The answers are controversial.

The Infectious Disease Society of America has told doctors that Lyme must be diagnosed by a rash or blood test. It claims that Lyme is easily treated by a round of antibiotics and that chronic Lyme may not really exist.

Many Lyme experts, patients and advocacy groups have cried foul, claiming exactly the opposite is true. They say that not every Lyme patient comes down with a rash and that the two blood tests available are not accurate enough to reliably catch Lyme. They say it often takes more than one round of antibiotics or alternative therapies to cure disease. And they tell horror stories of sufferers who were not treated early enough and who retain symptoms – pain, fatigue, and confusion – for years.

“It takes me an hour to fold the laundry. There are some days I can’t even do that,” said Gail Richard of Livermore Falls, who’s been dealing with Lyme since 2000. “Sometimes I’ll be talking to my husband and forget the names of things in the house. Like the dishwasher.”

Advocacy groups have called for the society to retract its guidelines. They say insurance companies have begun to use them as a reason to deny treatment.

Richard’s insurance refused to pay for more than 30 days of antibiotics, she said, even though her doctor requested at least 90 days. It’s refused to pay for some medications and refused full doses of others. She’s paid for a lot of it herself, spending about $3,000 not including deductibles.

“They say I should have been cured with the first round of antibiotics,” she said. “They say we don’t exist.”

Even a basic question – How many people have Lyme? – is up for debate.

Some Lyme patients believe that almost everyone has the disease, though symptoms only appear in certain people. Others don’t go that far, but do believe Lyme is drastically under-reported and that people diagnosed with Lou Gehrig’s disease, fibromyalgia or other illnesses actually have Lyme.

The National Centers for Disease control says just over 23,300 new cases were reported in 2005, nearly 250 of them in Maine. But even government agencies aren’t really sure how many Lyme patients are actually out there.

“We would definitely assume that Lyme disease is definitely under-reported,” said Geoff Beckett, epidemiologist with the Maine CDC.