The purpose of this study was to assess the number of cases and the clinical aspects of Lyme borreliosis in French-speaking Switzerland. From July 1996 to December 1997, all laboratories performing serological tests for Lyme borreliosis sent a questionnaire to the treating physicians whenever the tests were positive. In addition, the physicians who diagnosed a case on clinical grounds only were also asked to report these cases. During this period, 1460 positive serological tests were recorded among approximately 10,360 performed (14%). A total of 775 questionnaires were returned (53%). In 3/4 of the cases, the test was ordered because of an acute clinical manifestation or a tick bite. The rest related to chronic symptoms or follow-up. In 504 cases (65%), diagnosis was considered certain or probable. These were erythema migrans in 46%, clinical manifestations of stage II in 33% (26 facial palsy, 20 acute arthritis, 5 benign cutaneous lymphocytoma) and chronic symptoms in 21% (23 acrodermatitis, 26 neuropathies, and 8 arthritis). The adjusted incidence, estimated on the basis of the treating physician's place of residence, ranged from 9/100,000 in Valais to 95/100,000 in Neuchâtel. This study indicates that Lyme borreliosis is a diagnosis frequently looked for and established in French-speaking Switzerland. Although erythema migrans is the main clinical manifestation, symptoms of stage II and III indicate that Lyme borreliosis is also responsible for relatively major systemic morbidity.