Significance of EM rash---- a question

[cave76]

What can this mean?

From ILADS guidelines:

EM (bulls eye rash) and it's significance:

" The patient may relapse in the absence of another tickbite or erythema migrans rash (recurrent Lyme disease), or be poorly responsive to antibiotic treatment (refractory Lyme disease)."

Does this mean that relapse CAN occur if another EM appears with no new tick bite?
Does this confer a greater significance to the EM than just a symptom of infection?
Or what? I'm confused, again.

[I have to understand the world, you see."
Richard Feynman]

[mojogal]

I was going to say what Wonko said.

[cave76]

Thank you! I think you're probably right
Yes, the wording IS ambiguous------ and it's well known how I dislike ambiguity! LOL Or fuzzy language.

[wonko]

It sounds to me that the quoted text is saying that a relapse can occur even if there is no new bite or no new EM rash, and that relapses may not respond well to antibiotics.  I think the point of the quoted text is to dispute that recurring Lyme must be accompanied by an EM rash, since the rash is often what is highlighted to the public.

I think the wording is a bit ambiguous since they say "in the absence of another tick bit or erythema migrans rash."  The way I am interpreting it, it would say "in the absence of another tick bite and in the absence of an erythema migrans rash..."