Lyme disease: the promise of Big Data, companion diagnostics and precision medicine Raphael B Stricker,1 Lorraine Johnson2 1International Lyme and Associated Diseases Society, Bethesda, MD, 2LymeDisease.org, Chico, CA, USA Abstract: Lyme disease caused by the spirochete Borrelia burgdorferi has become a major worldwide epidemic. Recent studies based on Big Data registries show that >300,000 people are diagnosed with Lyme disease each year in the USA, and up to two-thirds of individuals infected with B. burgdorferi will fail conventional 30-year-old antibiotic therapy for Lyme disease. In addition, animal and human evidence suggests that sexual transmission of the Lyme spirochete may occur. Improved companion diagnostic tests for Lyme disease need to be implemented, and novel treatment approaches are urgently needed to combat the epidemic. In particular, therapies based on the principles of precision medicine could be modeled on successful “designer drug” treatment for HIV/AIDS and hepatitis C virus infection featuring targeted protease inhibitors. The use of Big Data registries, companion diagnostics and precision medicine will revolutionize the diagnosis and treatment of Lyme disease. Keywords: HIV/AIDS, hepatitis C virus, Big Data, designer drugs, protease inhibitors