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I've Been Bitten By a Tick! What Do I Do?

Jul 9, 2014
By Malcolm Thaler

More than a dozen tick-borne diseases from a variety of ticks have been identified in the US alone. Some you’ve heard of—Lyme disease and Rocky Mountain spotted fever—while some are less familiar—babesiosis, anaplasmosis, and Heartland virus.

The most common is Lyme disease, caused by a spiral-shaped bacterium, or spirochete, called Borrelia burgdorferi. While the incidence of Lyme disease is rapidly growing, the good news is that most tick bites can be prevented or treated.

What kind of ticks should I watch out for?

Black-legged Ixodes ticks carry the Lyme disease bacterium and like to feed off various animal hosts. The highly infectious young nymphs prefer the white-footed mouse while the larger, less infectious adults have a predilection for deer. Since these animals live in wooded areas with tall grass, you should avoid these places.

How do I prevent tick bites?

The first step is to avoid wooded areas, but if you’re a hiker or camper, minimize your risk by walking in the middle of paths and trails. Use insect repellent containing 20 to 30 percent DEET on all exposed skin and clothing, tuck pant legs into your socks, and wear long-sleeved shirts. Clothing treated with 0.5 percent permethrin, another repellent, will stay effective through several wash and dry cycles. And don’t forget your pets. Not only are pets susceptible to many diseases from ticks, they can also bring ticks into your home. Talk to your veterinarian about monthly flea and tick repellent treatments and if you have a yard, treat it with acaricides. One spraying in late spring will reduce the number of nymphs, and another in October will reduce adult ticks.

Don’t miss Protect Yourself from Poison Oak, Poison Ivy, and Poison Sumac.

What if I find a tick on my skin?

Don’t panic—not all ticks are capable of spreading Lyme disease. Ixodes nymphs are the size of a poppy seed and have black legs while adults are much larger, often a half inch long. The good news is that because the Borrelia spirochete lives in the midgut of the tick, and it takes at least 36 hours for the spirochetes to migrate to the tick’s salivary glands. Therefore, it’s very rare to get Lyme disease unless the tick is attached to your skin for at least 36 to 48 hours. In most cases of Lyme disease, the evidence suggests that the tick was attached for at least 72 hours.

No matter how long the tick has been attached, you want to get it off. Use tweezers or small forceps (or your fingers if no other tool is available), grasp the tick close to the skin and pull up firmly with steady pressure—no squeezing or twisting, which could push more saliva into the wound. Disinfect the skin and wash your hands with soap and water. If it looks like parts of the mouth are still in your skin, don’t worry—these aren’t dangerous and your body will expel them.

What do I do after I’ve been bitten?

If you know the tick has been attached for less than 36 hours, you have little concern. If it has been longer or you’re not sure, there are a couple of options:

Antibiotic Therapy

In carefully prescribed situations, you can take a single dose of doxycycline (200 mg), an antibiotic. This can significantly lower the risk of Lyme disease, but only makes sense if all of the following conditions are met:

  •       The tick is a nymph or adult Ixodes tick
  •       You know it has been attached for more than 36 hours and you can take the doxycycline within 72 hours of it being removed
  •       At least 20 percent of ticks in your area are infected with the Borrelia spirochete (this is the case in much of New England, the Mid-Atlantic states, Wisconsin, and Minnesota)
  •       You don’t have any conditions that prevent you from taking doxycyline (no other antibiotic will work)

Watch and Wait

More commonly, even in persons who meet all the criteria above, a watch and wait approach is fine. For the next 30 days keep an eye on the bite site for a rash and any flu-like symptoms (fever, muscle aches, etc). The typical Lyme disease rash, called erythema migrans, is usually painless and expands slowly over several days to resemble a bull’s-eye. A simple, small red lesion at the site of a tick bite is normal and doesn’t necessarily mean you have Lyme disease.

What do I do if I think I have Lyme disease?

If a rash or flu-like symptoms develop, see your healthcare provider. But don’t worry—diagnosed at this stage, Lyme disease is essentially 100 percent curable with antibiotic therapy.

Not every Lyme rash has all the classic features, so don’t hesitate to have your healthcare provider check it out if you’re unsure.

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Malcolm Thaler

Malcolm enjoys being on the front lines of patient care, managing diagnostic and therapeutic challenges with a compassionate, integrative approach that stresses close doctor-patient collaboration. He is the author and chief editor of several best-selling medical textbooks and online resources, and has extensive expertise in managing a wide range of issues including the prevention and treatment of cardiovascular disease, diabetes, and sports injuries. Malcolm graduated magna cum laude from Amherst College, received his MD from Duke University, and completed his residency in Internal Medicine at Harvard's New England Deaconess Hospital and Temple University Hospital. He joined One Medical from his national award-winning Internal Medicine practice in Pennsylvania and was an attending physician at The Bryn Mawr Hospital since 1986. He is certified through the American Board of Internal Medicine. Malcolm is a One Medical Group provider and sees patients in our New York offices.

The One Medical blog is published by One Medical, a national, modern primary care practice pairing 24/7 virtual care services with inviting and convenient in-person care at over 100 locations across the U.S. One Medical is on a mission to transform health care for all through a human-centered, technology-powered approach to caring for people at every stage of life.

Any general advice posted on our blog, website, or app is for informational purposes only and is not intended to replace or substitute for any medical or other advice. 1Life Healthcare, Inc. and the One Medical entities make no representations or warranties and expressly disclaim any and all liability concerning any treatment, action by, or effect on any person following the general information offered or provided within or through the blog, website, or app. If you have specific concerns or a situation arises in which you require medical advice, you should consult with an appropriately trained and qualified medical services provider.