No matter how careful you are and how much DEET you apply, you may eventually find yourself on the receiving end of a tick bite. The number of tick-borne disease cases in the U.S. — mostly Lyme disease — has more than doubled in the last decade, according to a 2018 report by the Centers for Disease Control and Prevention (CDC).
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But while it can be scary to look down and see a little black or brown critter stuck on you, there's no reason to panic.
Here's your step-by-step guide to treating a tick bite.
It's normal to feel freaked out if you see a tick on you. But the risk of getting a tick-borne infection is actually pretty low, because the majority of ticks don't carry disease, reassures Michael Cameron, MD, an assistant clinical professor of dermatology at Mount Sinai Hospital in New York City.
Because the deer tick that spreads Lyme disease feeds for more than 36 hours before it transmits the bacteria, the risk of getting Lyme disease from an actual tick bite is only 1.2 to 1.4 percent, even if you live in a part of the country where the disease is common, according to UptoDate.
2. Remove the Tick
The CDC has very specific instructions on how to remove a tick, because if you do it the wrong way, you can cause parts of the critter to be stuck in your skin.
- Use fine-tipped tweezers to grasp the tick. Get as close to the skin as you can.
- Pull upward with steady, even pressure. Don't twist or jerk the tick, because that could cause part of it to break off.
Don't use the following:
- Smoldering match or cigarette
- Nail polish
- Petroleum jelly
- Liquid soap
While these are all popular home remedies, they actually won't dislodge the tick, says Michael Zimring, MD, director of The Center for Wilderness and Travel Medicine at Mercy Medical Center in Baltimore and co-author of the book Healthy Travel.. In fact, it can make matters worse, because it can irritate the tick and cause it to release more fluid into the bite.
3. Clean the Bite
Once you remove the tick, clean the bite area with rubbing alcohol or soap and water.
4. Take a Look at the Tick
You'll want some information to share with your doctor, per UptoDate:
- Brown ticks the size of a poppy seed or pencil eraser are deer ticks. These are the ones that can transmit the bacteria that cause Lyme disease, as well as other tick-borne infections like babesiosis.
- Brown ticks with a white collar are probably dog ticks. They can carry another serious tick-borne infection called Rocky Mountain spotted fever.
- A brown to black tick with a white splotch on its back is a Lone Star tick. It can spread southern tick-associated rash illness (STARI), which causes a rash similar to the one you see with Lyme disease.
- If the tick was small and easy to remove, that's a good sign that it didn't transmit Lyme disease or any other infection because it hadn't yet started a blood meal.
- If the tick was larger, with a globular shape, it's taken a blood meal, and there's a higher risk that it could transmit a tick-borne disease. It needs to have fed for at least 36 hours to spread Lyme disease; it's not known how long it needs to stay attached to transmit other infections.
5. Flush the Tick Down the Toilet
You probably don't need to bring it to your health care provider, Dr. Cameron says. The labs that test ticks are not required to meet the same quality standards as laboratories used by clinics or hospitals, according to the CDC.
"A positive test can also be misleading, since even if a tick contains a bacteria, that doesn't mean you've been infected by it," Dr. Zimring says.
6. Call Your Doctor
In certain cases, your physician will want to treat you with a preventative dose of the antibiotic doxycycline if you meet all of the following criteria, according to the Infectious Disease Society of America:
- The tick was most likely a deer tick.
- The tick is estimated to have been attached for 36 hours or more (based upon how engorged the tick appears or the amount of time since outdoor exposure).
- It's within 72 hours of tick removal.
- The bite occurred in an area where there's a high incidence of Lyme disease, like Pennsylvania, New York, New Jersey, Maine, New Hampshire or Wisconsin. (You can look up your state here.)
If you meet all of the above criteria, your doctor will likely give you a single 200 mg dose of doxycycline.
7. Watch for Symptoms
If you don't fit the bill to get treated right away, then you'll need to just watch for symptoms for the next 30 days. There's no need to actually get tested for Lyme disease.
"Antibodies can take several weeks to develop, so you may test negative if it's a very recent infection," Dr. Cameron points out.
In addition, if you've ever had Lyme disease before, antibodies can remain in your blood for months or even years, so a positive test doesn't necessary mean you're sick, adds Dr. Zimring.
Instead, watch for a rash. About 80 percent of people with Lyme disease develop a rash, otherwise known as erythema migrans.
While most of the time when you think of the "classic" bulls-eye rash when it comes to Lyme disease, it can also show up as a plain red rash, Dr. Cameron says. Common areas include in and around the ears or hair, under your arms, inside your belly button, around your waist, between your legs or on the back of your knees.
Other symptoms include:
- Extreme fatigue
- Muscle pain
- Joint swelling and pain
Most people don't notice itching and swelling around the bite, although it can happen, especially as part of an allergic reaction.
If you experience any of the above symptoms, call your doctor immediately.
The good news is that early Lyme disease can be treated easily with oral antibiotics, usually doxycycline for two to three weeks, or, if for some reason you can't take that, amoxicillin or cefuroxime.
While you may have heard of long-term Lyme disease, that's a myth, says Dr. Zimring. But anywhere from 10 to 20 percent of people do develop Post-Treatment Lyme Disease Syndrome (PTLDS), a condition where symptoms linger for up to six months, per an August 2018 paper in The New England Journal of Medicine.
"It may be because the bacteria that cause Lyme disease trigger an auto-immune response that causes symptoms even after the infection itself is gone," explains Dr. Zimring. "Usually, this resolves over time."
- Centers for Disease Control and Prevention: Vital Signs: Trends in Reported Vectorborne Disease Cases — United States and Territories, 2004–2016
- UptoDate: Patient education: What to do after a tick bite to prevent Lyme disease (Beyond the Basics)
- Centers for Disease Control and Prevention: Tick Bite: What to Do
- Infectious Disease Society of America: Clinical Practice Guidelines by the Infectious Diseases Society of America (IDSA), American Academy of Neurology (AAN), and American College of Rheumatology (ACR): 2020 Guidelines for the Prevention, Diagnosis and Treatment of Lyme Disease
- UptoDate: Patient Information Lyme Disease Treatment (Beyond the Basics)
- The New England Journal of Medicine: Tick-born Diseases: Confronting a Growing Threat