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How to Handle a Tick Bite

What You Should Know About Blacklegged Tick Bites

When it comes to Lyme and other tick-borne illness, prevention is the best form of medicine. When spending time in areas where ticks may be present, wear long sleeves and pants, tuck your pants into your socks, and wear tick repellent containing DEET, picaridin, IR3535, or oil of lemon eucalyptus. Pretreat outdoor clothing and gear with permethrin, an insecticide that kills ticks on contact. Clothing can be treated at home with sprays or dips that are effective for 2-6 weeks (and last through multiple washings). Always check yourself for ticks after each potential exposure; check pets, even those treated with tick repellents, after every trip outside. For more on tick bite prevention, see our Lyme brochure.

If you are bitten by a tick, here is information you should have.

The information below is for educational purposes only. It is not intended to replace or supersede patient care by a healthcare provider. If you suspect the presence of a tick-borne illness, you should consult a healthcare provider who is familiar with the diagnosis and treatment of tick-borne diseases.

Handling a Tick

Should I remove a tick and how? 

Yes, remove a tick. But do not manhandle the tick by squeezing it, putting Vaseline over it, or holding a hot match to it, as this may increase the chance of transmitting disease.

The tick should be removed with fine pointed tweezers. Grasp it from the side where it meets the skin, and, using steady gentle pressure, gently pull in the opposite direction from which it embedded, until the tick is released. Expect to see the skin “tent” as you gently pull. Place the tick in a lidded container or zip-lock bag. Wash and disinfect the bite site, your hands, and your tweezers. Avoid handling the tick.

If you use a tick removal device like a tick scoop or tick key, follow the directions given on the package for safe and effective use.

How long does a tick need to be embedded for it to transmit disease?

The longer a tick is attached, the higher the risk of transmission. Although Lyme disease is not commonly transmitted when ticks are attached for less than 24 hours, the risk of Lyme disease posed by those bites is not zero. There may be other factors that contribute to disease transmission in short duration attachments. In addition, there are other disease-causing bacteria and viruses carried by blacklegged ticks that are known to be transmitted in less than 24 hours.

Should I save the tick?

Yes. It is a good idea to save the tick so that your doctor can identify its species and whether it has signs of feeding. Some people also save the tick to have it tested for Borrelia burgdorferi (the bacterium that causes Lyme) or other tick-borne pathogens.

Should I call my doctor right away, or wait to see if I develop symptoms?

ILADS recommends immediately contacting your health care provider. There are steps you can take to prevent a Lyme infection, as explained below.  The onset of Lyme disease symptoms can be overlooked or mistaken for other illnesses. Once symptoms are more evident, the disease may have already entered the central nervous system, and could be hard to cure. Immediate care may prevent this from happening.

Managing a Known Tick Bite

If bitten by a tick, should I consider immediate antibiotics to prevent Lyme disease?

ILADS recommends that prophylaxis (preventive treatment) be discussed with all who have had a blacklegged tick bite. An appropriate course of antibiotics has been shown to prevent the onset of infection.

When the decision is made to use antibiotic prophylaxis, ILADS recommends 20 days of doxycycline (provided there are no contraindications). The decision to treat a blacklegged tick bite with antibiotics often depends on where in the country the bite occurred, whether there was evidence that the tick had begun feeding, and the age of the person who was bitten.  Based on the available evidence, and provided that it is safe to do so, ILADS recommends a 20-day course of doxycycline.

Patients should also know that although doxycycline can prevent cases of Lyme disease, ticks in some areas carry multiple pathogens, some of which, including Babesia, Powassan virus, and Bartonella, are not responsive to doxycycline. This means a person could contract a tick-borne illness despite receiving antibiotic prophylaxis for their known tick bite.

ILADS recommends against single-dose doxycycline. Some doctors prescribe a single 200 mg dose of doxycycline for a known bite. However, as discussed in detail in the guidelines, this practice is based on a flawed study that has never been replicated. Read more in the ILADS treatment guidelines.

The bottom line: If you have been bitten by a blacklegged tick, you should discuss immediate antibiotic treatment with your provider as a possible course of action.

If I take antibiotics to prevent Lyme, and then have a negative test, am I Lyme-free?

If you do receive prophylactic treatment, be cautious in in interpreting the results of subsequent testing. Widely-used blood tests look for antibodies to Borrelia burgdorferi, but early treatment can prevent the body from mounting an antibody response. Should you become infected despite prophylactic treatment, subsequent tests results could be falsely negative.

If I decide not to take antibiotics to prevent Lyme, what should I do?

Whether or not you choose to get prophylactic treatment after a tick bite, it is imperative to be vigilant for symptoms that might suggest active infection. Common Lyme symptoms include fever, headache, muscle and joint pain, and fatigue.