Follow these steps to reduce your risk of contracting Lyme disease following a tick bite.
Q1: Is the tick embedded in your skin?
If you find an attached tick, it is very important not to distress it in any way by using any kind of oil, a match, your fingers, blunt tweezers or anything else not designed for the job.
If you have not yet removed the tick, take a photo of it whilst embedded (but do not delay removal if you don’t have a camera to hand) and then quickly, and safely, remove the tick using the guidance available here.
If you do not have a tick removal tool, it is possible to use dental floss, a fine thread or a hair and tie a loop around the mouthparts of the tick and pull smoothly upwards and outwards. Do not twist.
If your attempt to remove the tick fails, please seek medical advice immediately from a GP or NHS walk-in centre. If you cannot access these services, call NHS 111 for advice. If you notice the tick’s mouthparts are still embedded, there is no need to seek advice, as the body will expel them like any other foreign body. However, it’s a good idea to keep an eye out for any localised infection around the area that might require antibiotics.
Q2: Have you been bitten anywhere else on your body?
Complete a thorough tick check to ensure you don’t have any other bites elsewhere, remembering that ticks can be as small as a poppy seed and bites can be easy to miss. Ticks also like to hide, so carefully check areas such as between toes, in the groin, under your waistband and particularly for children, around the hairline.
If you know when you were bitten and you were with other people, advise them to check for ticks or perform a check on them. Also thoroughly check your pets, remembering to look in paws, mouths, ears and under legs.
Have a shower and put all clothes unwashed in the tumble dryer on the highest heat possible for at least 10 minutes. If a tumble dryer is not available then wash your clothes at a high temperature.
What to do next
1. Clean the bite site
Disinfect the bite site with an antiseptic wipe or wound wash and wash your hands with soap and water.
2. Monitor the bite site and symptoms
Draw around the bite site with a pen and take another photo. Or, place a coin next to the bite site and take a photo so that any changes in size can be tracked. Keep a photo record of any changes and look out for any rashes which may appear. Keep in mind only a relatively small proportion of ticks carry the bacteria that causes Lyme disease.
It is worth noting that some people will notice some irritation, swelling and redness during the first couple of days following a bite which then recedes. This can be a histamine reaction to the bite and does not always mean that Lyme disease has been contracted.
Start keeping a close eye out for any symptoms during the coming days/weeks/months, remembering that symptoms may have a delayed onset and fluctuate. Some early symptoms are listed here. Also be on the lookout for changes in mood/behaviour, particularly in children, as these can be the first noticeable symptoms and they may be too young to articulate problems. You may find our guide to supporting a child with acute Lyme disease helpful which you can access here.
If you have a rash that appears immediately after a bite it is more likely to be a local histamine reaction to the bite. However, there is a specific rash known as an EM (Erythema Migrans) rash that indicates Lyme disease. In its most classic form, it can resemble a bull’s-eye, but the key characteristic is the spreading of the rash. It is important to be aware that EM rashes can be varied in appearance but can appear as a solid rash or have a bruise-like appearance. They can look very different on darker skins and may be difficult to spot.
The rash is usually delayed after a bite and can appear any time between 3 days to 3 months after a bite. An exception to this could be if the tick attachment time is very long, as the infection may have happened earlier than expected based on tick removal time. Another exception would be if someone has been bitten multiple times without noticing before the known time of removing a tick.
Many people don’t get an EM rash but if you do, it means you have been infected with Lyme disease. A blood test is not necessary for diagnosis and treatment for Lyme disease needs to start immediately.
Rashes tend to be painless, flat and not itchy. Draw around the rash with a pen and take a photo or place a coin next to the bite site and take a photo so that changes in size can be monitored.
If you do develop any symptoms or rash, be sure to keep a detailed symptom diary and seek medical attention quickly.