By Heather Lesage-Horton, MD

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 host (a human or pet), it is important to identify the type of tick to know if a person or pet is at risk for Lyme disease.  If it is determined to be 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 an area where there are ticks.  Think about walks in the woods or playing in or around tall grass.

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

So it’s a deer tick, now what?

Remove the tick by using tweezers or a tick tool to 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 person’s skin after the tick has been removed.  If parts of the tick’s mouth remains attached, do not go after it – the human body will naturally get rid of 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 we think about giving an antibiotic to try to prevent the bitten person from developing Lyme disease.  We think about this because here in the Northeast more than 20% of ticks (more than 1 in 5) are infected with the germ (Borrelia burgdorferi) that causes Lyme disease.  We do not test ticks to see if they have Lyme disease because even if the tick has Lyme disease, 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 for that child if the 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.

So 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. Some people may also experience a decrease in 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% DEET or permethrin treated clothing).  Shower/take a bath after being outdoors.  Do tick checks everyday – especially check under the arms, in and around ears, inside the belly button, around the waist and on the hairline and scalp.


Heather Lesage-Horton, MD, is a board-certified pediatrician at Just So Pediatrics, a department of Brattleboro Memorial Hospital. Just So Pediatrics is located at 19 Belmont Avenue, Brattleboro, VT. In addition to regular hours evening hours are available on most Tuesdays and Wednesdays until 8 PM.  Just So Pediatrics can be reached at 802-251-8626.