How to Prevent and Treat Tick Bites and Lyme Disease
A definitive guide
This story is part of “Tickpocalypse,” a multi-part special report.
Lyme disease first made headlines in 1975, when word began to spread that a mysterious illness — marked by fevers, joint and muscle pain, and fatigue, among other symptoms — was affecting the residents of the leafy New England shore town of Old Lyme, Connecticut. Now the condition is having another moment, this one no more welcome than the first.
Between 1991 and 2014, the number of Americans infected with Lyme disease roughly doubled. From 2016 to 2017 alone, rates of the illness jumped nearly 20%, according to the Centers for Disease Control and Prevention (CDC). And as if that weren’t troubling enough, experts say we are on the brink of a Lyme disease epidemic brought on by an explosion in the tick population. (Lyme is transmitted by ticks infected with the Borrelia burgdorferi bacteria.)
“The distribution of Lyme continues to expand,” says A. Marm Kilpatrick, an associate professor of ecology at the University of California, Santa Cruz who has studied the potential causes and spread of Lyme disease. “And there are many challenges in managing it.”
Lyme disease is most common in the mid-Atlantic region, the Upper Midwest, and the Northeast, but it has now been identified in all 50 states and the District of Columbia. Ticks are active any time the temperature rises above freezing, but they’re most likely to bite and infect people during the spring and summer months. Here’s what you need to know to keep yourself and your family safe.
How to prevent tick bites
Ticks are parasitic arachnids that feed on the blood of humans and other mammals. They need this blood in order to grow and reproduce. In the U.S., there are seven common species of ticks that bite people, and all of them can transmit diseases. But the blacklegged tick is the primary carrier of Borrelia burgdorferi.
Ticks can turn up pretty much everywhere outdoors. But they’re found mostly in and around woods and forests, as well as in grassy fields, according to resources from Purdue University. Blacklegged ticks tend to hang out on ferns, shrubs, tall grass, old stone walls, and fallen trees or stacked logs. Ticks like these places, in part, because they can’t fly, they can’t jump, and they’re slow. In order to climb onto people or animals, they have to wait for someone or something to brush past.
Sticking to pathways or trails that are wide and sunlit is one of the best ways for people and their pets to avoid ticks. (Ticks can latch onto dogs or cats, and so make their way into your home.) But if your path through the woods is narrow, that’s about as risky as hiking off-trail.
If you’re venturing out in tick-infested areas, repellents that include DEET or picaridin are safe and effective, according to the CDC. “Natural” repellents that include essential oils of garlic, rosemary, and other plants will also repel blacklegged ticks, according to the Environmental Protection Agency (EPA). Wearing jeans and tucking them into your socks is another good way to prevent bites. But you’ll want to remove your clothes and dry them on high heat for about 50 minutes as soon as you’re home. (Ticks can survive washing and low-heat drying.)
Spraying your clothing and boots with a product that contains permethrin, an insecticide — or buying gear pre-treated with permethrin — will also keep ticks away, per the CDC.
How to locate and remove ticks
Even if you take precautions, it’s a good idea to check your body for ticks after spending time outdoors — though this is a little easier said than done because they are tiny.
It helps to know where ticks hide. According to the CDC, ticks are fond of setting up shop on the backs of the knees, in the armpits, behind the ears, in the groin, on the scalp, and around the waist — including in the belly button.
If you find a tick, get it out or off of your skin right away. “It takes time for the tick to transfer over the bacteria that causes Lyme disease,” says Dr. Alan Barbour, a professor of medicine and microbiology at University of California, Irvine and author of the book Lyme Disease. If you have tweezers or some kind of tick-removal tool at your disposal, great. Pinch the tick where its mouth joins your skin and slowly but firmly pull until it releases itself or breaks apart.
But don’t wait until you have access to tweezers or a tool to remove a tick. The longer a tick’s in, the more likely it is to transmit pathogens, Barbour says. Even if you have to just pull the tick out with your fingers, you want to get it out immediately.
Its “mouthparts” may not come out completely, but that’s not unusual. Clean the bite site with alcohol or soap and water, and then apply Neosporin or some other antibacterial ointment.
What to do after you’ve been bitten
First, don’t panic. Not all ticks transmit disease.
Keep a close eye on the bite site. You can ignore a small raised red bump — something that looks like a mosquito bite. But if a larger welt or a rash develops, especially a rash that looks like a bull’s-eye, see a doctor. Ditto if you have a fever or other flu symptoms — or if you have muscle aches or chills — within a few weeks of being bitten. These are all indicative of a Lyme disease infection.
What your doctor will do
If you notice a tick bite and you’ve developed a rash or Lyme symptoms, most doctors will diagnose the disease based on this clinical evidence, Barbour says. The standard treatment is a two- to three-week course of antibiotics.
There is a blood test for Lyme disease, but the antibodies the test searches for often aren’t detectable during the disease’s earliest stages, he explains. So don’t be surprised if your doctor diagnoses you without ordering a blood test.
The lasting effects of Lyme disease are controversial.
Dr. John Halperin, a professor of neurology and medicine at the Sidney Kimmel Medical College of Thomas Jefferson University, has studied Lyme disease since the 1980s. He emphasizes that Lyme disease is highly treatable when detected early and that most people who contract the illness recover fully after the standard course of antibiotics.
In untreated patients, the Lyme disease infection can get into the blood, heart, joints, or brain and cause problems. These include severe headaches, neck pain or stiffness, a type of facial weakness and drooping known as palsy, and arthritis-like joint pain and swelling — especially in large joints like the knee, Halperin says.
In rare cases, people may experience an irregular heartbeat, nerve pain, or dizziness. But even in these situations, most will respond to antibiotic treatment, he says.
A small subset of patients may continue to experience symptoms like headaches, pain, or fatigue even after all the Lyme disease-related bacteria are cleared from their system, Barbour says. Known as post-treatment Lyme disease syndrome, or PTLDS, these symptoms may last for a few weeks or months. But they, too, eventually go away.
Barbour and others make a point of differentiating PTLDS from so-called chronic Lyme. That term applies to a range of lingering health issues many people attribute to Lyme disease, but for which there’s little scientific evidence of a connection.
Halperin says that with all the talk these days of ticks and Lyme disease, it’s common for some people to believe they have lasting symptoms from the illness, or to attribute otherwise unexplained symptoms to it. Maybe you just never noticed the tick bite or resulting rash — or you thought you had the flu a while back, and now you’re wondering if Lyme disease was to blame.
In that case, what should you do? See a doctor, Halperin says. “Contrary to what you may read online, once you’re out of the first month after a bite, testing for Lyme disease is very accurate and antibiotics are effective,” he says. If you have no Lyme-related antibodies in your system, he says, you can rule out Lyme disease as the cause of your symptoms and you and your doctor can explore other explanations.
This story is part of “Tickpocalypse,” a multi-part special report.