Tick Bites – What Do I Need to Know?

Why are tick bites important?

Most tick bites do not cause any illness, so if you find a tick on your skin there is no need to panic. However, they are worth taking seriously because ticks can be very small and easy to miss, and some carry infections – most importantly Lyme disease.

In general, the longer an infected tick remains attached and feeding, the greater the chance of infection, which is why prompt removal is important.

Ticks can transmit a number of different infections depending on where in the world you are. These include Lyme disease, Tick-borne encephalitis and, in some countries, rickettsial infections such as Rocky Mountain spotted fever. Tick bites can also rarely, trigger alpha-gal syndrome, an unusual delayed allergy to mammalian meat and other products containing alpha gal.

What should I do if I find a tick attached to my skin?

The most important thing is to remove it promptly.

Use fine-pointed tweezers or a purpose-made tick-removal tool. Grasp the tick as close to the skin as possible, around its mouthparts rather than its swollen body, and pull slowly and firmly upwards. Try not to squeeze or crush the tick.

Don’t try to burn it off or cover it with substances such as vaseline or alcohol, as this may make removal more difficult.

Once it is out, clean the skin. I also suggest taking a photograph of the area and making a note of the date. You can then keep an eye on both the bite site and how you feel over the following few weeks.

Unlike in some parts of the United States, in the UK we do not routinely prescribe antibiotics simply because someone has had a tick bite.

Where in the world are tick bites most worrying?

There isn’t one particular country where tick bites are necessarily the most worrying, because different ticks carry different infections in different parts of the world

We pay particular attention to tick bites in central, eastern and northern Europe and across parts of Russia and northern Asia, where both Lyme disease and tick-borne encephalitis occur.

Lyme disease is also relatively common in parts of the north-eastern, mid-Atlantic and upper-midwestern United States. Other potentially serious tick-borne infections occur in the southern United States, the Mediterranean, Africa, the Middle East and parts of Asia.

So, if you have been bitten abroad, it is very helpful to tell your doctor exactly where you were, when the bite occurred and what you were doing at the time.

Should I worry about a tick bite in the UK?

No, because the great majority of tick bites in the UK do not result in illness. Nevertheless, they shouldn’t be ignored.

The main infection we think about in the UK is Lyme disease. It occurs throughout the country, particularly in areas of woodland, heathland and long grass such as in the New Forest or in Richmond Park or other areas with a deer population.

Tick-borne encephalitis has also occasionally been acquired in the UK, but it remains extremely rare.

Where is tick-borne encephalitis found, and do I need to be vaccinated?

Tick-borne encephalitis, or TBE, occurs mainly in parts of Europe and northern and eastern Asia.

Importantly, you don’t automatically need a TBE vaccination simply because you are visiting a country where the infection occurs. The risk depends on exactly where you are going, the time of year, how long you will be there and what you are planning to do.

I would particularly think about vaccination if you are going to spend significant time hiking, cycling, camping or walking in woodland, forests or long grass in an affected area.

Countries where TBE occurs include Austria, the Czech Republic, Slovakia, Slovenia, Estonia, Germany, Switzerland, Poland, Finland, Sweden and parts of Norway, Denmark, France, Italy, Romania, Bulgaria and Serbia, amongst others.

If you are planning this sort of trip, it is worth discussing your itinerary with your GP rather than deciding on vaccination simply on the basis of the country you are visiting. We stock the vaccine routinely.

Where is Lyme disease found, and is there a vaccine?

Lyme disease occurs predominantly in the temperate northern hemisphere. It is found across much of Europe, including the UK, and in parts of North America.

There is currently no Lyme disease vaccine available for routine human use. A new vaccine is in late-stage clinical trials, so this may change in the future.

What are the early symptoms of Lyme disease?

The best-known early sign is a rash called erythema migrans.

People often describe this as a “bull’s-eye” rash, but this can be misleading because it doesn’t always look like a neat bull’s-eye. It is usually a gradually expanding red or pink area of skin, often becoming larger than 5 cm. It isn’t usually particularly painful, hot or itchy.

It typically appears between about 3 and 30 days after the bite, although not everybody with Lyme disease develops or notices a rash.

Other early symptoms can be rather non-specific and may feel a little like having flu: tiredness, fever, headache, muscle or joint aches and sometimes swollen glands.

If you develop an expanding rash after a possible tick bite, or become significantly unwell in the weeks afterwards, I would advise contacting your GP straight away.

How is Lyme disease treated?

The reassuring thing is that Lyme disease is treatable with antibiotics, and treatment is particularly effective when the infection is recognised early.

For an adult with the characteristic erythema migrans rash or other uncomplicated early Lyme disease, doxycycline is commonly used. Amoxicillin is an alternative when doxycycline isn’t suitable.

The antibiotic, dose and length of treatment may be different for children, during pregnancy, or if Lyme disease is affecting the nervous system, heart or joints. More complicated disease sometimes requires specialist advice and intravenous antibiotics.

Importantly, if someone has a characteristic erythema migrans rash, we don’t need to wait for a blood test before starting treatment.

When should I have a blood test for Lyme disease?

This is an area where there is quite a lot of misunderstanding.

If you have had a tick bite but remain completely well, we do not routinely recommend a Lyme blood test. Testing an asymptomatic person after a tick bite isn’t particularly helpful and can sometimes cause more confusion than reassurance.

If you develop symptoms that could represent Lyme disease but don’t have the characteristic erythema migrans rash, then blood testing is appropriate.

The timing matters because Lyme antibody tests can be negative during the first few weeks of infection. If clinical suspicion remains despite an early negative test, your doctor may recommend repeating it later.

If you develop a typical expanding erythema migrans rash, however, don’t wait for a blood test – contact your doctor, as Lyme disease can usually be diagnosed clinically and treatment should be started promptly.

Are tick bites and Lyme disease becoming more common in the UK?

We don’t have a complete national count of every tick bite, so it is difficult to say exactly how frequently people are being bitten.

However, ticks appear to be becoming more widely distributed and may remain active for longer periods. Changes in climate, habitat, wildlife populations and the amount of time we spend outdoors are all likely to influence this.

Lyme disease is therefore something both doctors and patients are increasingly aware of. Reported laboratory-confirmed cases fluctuate from year to year, and the official figures underestimate the true number because people with a typical erythema migrans rash are usually treated without needing a blood test.

What is alpha-gal syndrome?

Alpha-gal syndrome is quite different from Lyme disease. It isn’t an infection but an unusual allergy that can develop after certain tick bites.

The allergy is to a carbohydrate called galactose-alpha-1,3-galactose (alpha-gal), which is present in most non-primate mammals.

What makes this allergy particularly unusual is that the reaction is often delayed. Rather than reacting immediately after eating, someone may develop symptoms several hours after eating red meat or being exposed to another product containing alpha-gal.

Symptoms can include hives, itching, flushing, abdominal pain, nausea, vomiting or diarrhoea. Occasionally the reaction is much more severe and can cause wheezing or anaphylaxis. Alcohol, exercise and non-steroidal anti-inflammatory medicines such as ibuprofen can sometimes make reactions worse.

Alpha-gal syndrome was first strongly associated with the Lone Star tick in the United States, but it has subsequently been recognised after bites from other tick species in Europe and Australia.

Thankfully, it appears to be extremely uncommon in the UK.

So, what should I remember if I have been bitten by a tick?

Above all, don’t be anxious. Most tick bites cause no illness at all.

Remove the tick promptly and correctly, clean the area, take a photograph and make a note of the date. Then keep an eye on the area and on how you feel over the following few weeks.

You don’t need a Lyme disease blood test or antibiotics simply because you have been bitten but we are always happy to consult with you if you are worried.

However, if you develop an expanding red rash, particularly one that becomes larger over several days, or if you develop fever, marked tiredness, headache, muscle or joint pains or otherwise feel unwell following a tick bite, please seek medical advice immediately and mention the tick bite.

If the bite happened while you were abroad, tell your doctor exactly where you had been, as the infections carried by ticks vary considerably around the world.

Concerned about a tick bite or planning a trip?

If you have been bitten by a tick and are concerned about the bite or any symptoms you have developed, or would like advice about tick-borne infections and vaccination before travelling, one of our doctors would be happy to help.

You can book an appointment online here or call us on 020 7245 9333.