So you have a tick bite, what type of tick is it?

Lyme disease is spread through the bites of nymph or adult Deer ticks, also known as “Black Legged” ticks.  If a tick is found on a human or pet, it’s important to identify the type of tick to know if the person or pet is at risk for Lyme disease.  If it’s a black legged tick, your health care provider will want to know if it has been attached to the person and for how long.

How long has the tick been attached?

It can be difficult to determine how long a tick has been attached.  To help with this, think about times when you may have been in areas where ticks are often found;  for example, in the woods in or around tall grass.

Lyme disease is rarely passed on during the first 48 hours (two days) a tick is attached.  To pass on Lyme disease, the tick will typically be engorged (swollen). This means the tick has had a blood meal. Ticks need to eat to pass on Lyme disease.

Yes, it’s a deer tick…now what?

Remove the tick with tweezers or a tick tool. Grab the tick as close to the bitten skin as possible.  Pull straight up with steady pressure (or follow tick tool directions).  Do not squeeze, crush, or injure the body of the tick.  Clean the skin once the tick has been removed.  If parts of the tick’s mouth remain attached, do not go after it! The human body will naturally rid it with time.

When you see or talk with your health care provider about a tick bite, they will need to know how long it has been since the tick was removed.  If it has been 72 hours (three days) or less, the tick is a Black Legged tick, and it has been attached for 36 hours or more (some people may use 24 hr. or more) we may recommend antibiotic prophylaxis.

This means giving an antibiotic to try to prevent the bitten person from developing Lyme disease.  That’s because here in the Northeast more than 20 percent of ticks (more than 1 in 5) are infected with Borrelia burgdorferi, the germ that causes Lyme disease.  We do not test ticks for Lyme disease because even if the tick has it, we do not know if it passed the disease on to the person it bit.

So, I meet criteria for antibiotic prophylaxis…what does that mean?

This is where it gets a little more complicated.  If the bitten person is eight years or older, has had a black legged tick on them for 36 hours or more, and it has been 72 hours or less since the tick has been removed, we can prescribe a one-time dose of Doxycycline.

We do not routinely recommend doxycycline in children less than eight years old due to the risk of staining of teeth.  However, we may consider a one-time dose of doxycycline if the child’s parents are willing to accept this risk.  We may also consider doxycycline if future tick bites happen.  We do not have recommendations for antibiotic prophylaxis if a patient has an allergy to doxycycline.

I’ve been bitten by a black legged tick. How do I know if I have Lyme disease?

Whether you received Lyme disease preventative antibiotics or not, it is important to know and watch for signs of Lyme disease.  Watch the area of the tick bite; at first redness may be noted. This is a reaction/response of the body at the site of the tick bite and is typically the size of a quarter or smaller.

Over the first month after the tick bite, watch for spreading redness or a bull’s eye rash as this could be a sign of Lyme disease. The rash usually does not hurt, but some patients report burning or itching.  If this develops, most people will have one bull’s eye rash. But some people may have more than one on different parts of the body. Others may also experience low energy, mild headache, muscle or joint pain, and/or swollen lymph nodes in the area of the tick bite.

In rare cases, if Lyme disease is not diagnosed early, patients may develop more severe illness weeks to months after the tick bite.  If you are worried about late symptoms of Lyme disease, please talk with your health care provider.

How do I prevent Lyme disease?

Wear shoes and keep your skin covered with clothing when you go outside.  Wear light colors so you can more easily spot ticks. Use bug spray to keep ticks off of you (consider 20 percent DEET or permethrin treated clothing).  Shower/take a bath after being outdoors. Perform tick checks everyday. Look closely under the arms, in and around ears, inside the belly button, around the waist and on the hairline and scalp.


Author Heather Lesage-Horton, MD, is a board-certified pediatrician at Brattleboro Primary Care. 802-258-3905