Tick Bites and Lyme Disease: What to Do After a Bite and When to Be Seen

What it involves

MedlinePlus says ticks are small bugs that attach to the skin and draw blood, and that most tick bites are harmless but some can cause mild to serious illness. Lyme disease is a bacterial infection spread through the bite of certain ticks, and MedlinePlus says most people who are bitten by a tick do not get it.

Who this is for

• Adults who found a tick on their skin and are not sure what to do next
• Patients with a spreading red rash, fever or aches in the weeks after a bite
• People who hike, garden or travel to areas where Lyme disease is common
• Anyone who removed a tick days ago and wants to know what to watch for

What to expect

• Questions about when and where you were bitten, how long the tick was attached and where you have traveled
• A look at the bite area and any rash, plus a review of symptoms such as fever, headache and joint pain
• A discussion of whether blood tests or antibiotic treatment make sense in your situation
• Clear instructions on what to watch for over the next weeks, and when to come back or go to the emergency room

How to remove a tick

The MedlinePlus tick bite article gives these steps. Use tweezers to grasp the tick as close to the skin as possible, then pull straight up with steady pressure. Do not jerk or twist it, and do not squeeze or crush the body, because fluids from the tick may carry infectious agents. Clean the skin well with soap and water and wash your hands. If you cannot get it all out or are unsure, a primary care visit can help. Noting the date you found the tick matters for what comes next.

How long a tick has to be attached

MedlinePlus says a tick usually has to stay attached for 2 to 3 days to pass on Lyme disease in one article, and 24 to 36 hours in another, which is why removal as soon as you notice it matters. It adds that blacklegged ticks can be so small they are almost impossible to see, so many people with Lyme disease never remember a tick. Other infections can pass earlier. That uncertainty is the reason providers ask when you were outdoors and where, not only whether you saw a tick.

Where Lyme disease is common

MedlinePlus says most Lyme disease infections in the United States occur in the Northeastern states from Virginia to Maine, the north-central states, mostly Wisconsin and Minnesota, and the northwest coast. That makes your travel history important at a Palm Beach County visit. A hiking trip to New England or the upper Midwest within the last month matters more than a walk in the yard, and a provider will ask. Telling the office about recent trips when you book helps the visit start in the right place.

Symptoms to watch for after a bite

MedlinePlus says to watch for symptoms in the weeks after a bite, including muscle or joint aches, stiff neck, headache, weakness, fever and swollen lymph nodes, and to look for a red spot or rash at the bite site called erythema migrans, which can look like a bull's eye. It advises watching the area for up to 30 days. Symptoms of early Lyme disease resemble the flu and may come and go. If joints become swollen, the swollen joints guide explains how that is evaluated.

Testing and treatment, as MedlinePlus describes them

MedlinePlus says the Lyme blood test looks for antibodies, that a positive first test must be confirmed with a second test, and that results can be normal early in the infection. It says a single dose of doxycycline may be given soon after a bite when several conditions are all true, including the tick being attached at least 36 hours and treatment starting within 72 hours. Diagnosed Lyme disease is treated with a course of antibiotics. Your provider decides what applies to you, and any antibiotic is a prescription decision made at the visit.

When to go to the emergency room

The MedlinePlus article describes a rare tick paralysis that starts with weakness in the legs a few days after a bite and can progress to trouble breathing, especially in children. Seek emergency care for difficulty breathing, spreading weakness, a stiff neck with fever and confusion, or chest pain with shortness of breath, which MedlinePlus lists as possible heart effects of later Lyme disease. For a bite that is simply itchy or a rash that is small and not spreading, an office visit is the right place. See also the insect bites and stings guide.

Sources

• MedlinePlus: Tick bite (medical encyclopedia)
• MedlinePlus: Lyme disease (medical encyclopedia)
• MedlinePlus: Lyme disease blood test (medical encyclopedia)