Updated: Aug 27, 2019
I have been asked several times over the last week about tick bites and lyme disease. Seeing as ticks are endemic to Brighton, I decided to post answers to common questions about ticks and lyme disease. Please note that I cannot comment on questions related to diagnosis of Lyme disease.
1) “What is the best way to remove ticks?”
There are many anecdotal ways to remove them, but only using blunt tweezers to grab closest to tick’s head and pulling away from the skin (without twisting) is the safest. The method removes the entire tick with the highest chance of removing its head and mouth attached, and with the least likelihood of causing its potentially infectious fluids to enter the skin.
Other methods of removing ticks (ie: applying vaseline, nailpolish, rubbing alcohol, burning the tick with a match) do not cause the tick to die and fall off. Because the tick cements itself to the skin, even if the tick was killed its mouth parts would stay lodged in the skin.
2)”I removed the tick, but some of it is still in the skin! What do I do?”
In short, try to remove what is left, but if you cannot most likely nothing serious will happen.
Leaving the mouth parts in the skin can cause skin infections that may be unrelated to Lyme disease (just like leaving a splinter in the skin). You can try to remove the parts using tweezers, but if you cannot reasonably do so, leave them in but clean the area with water, rubbing alcohol or another antiseptic product. As the skin heals the mouth parts will eventually fall out.
Addendum: According to a local physician: Having the tick still partially in the skin will NOT increase your risk of contracting lyme disease.
3) “Should I save the tick?"
Yes, you should save the tick. Your physician may want to simply confirm that it is indeed a black legged tick.
4)”I was bitten by a tick do I have lyme disease?”
Only your physician can tell you that. But if you have found a tick that has been attached for more than 24 hours or if you do not know how long the tick has been attached make an appointment with a physician as soon as possible, regardless if you feel any symptoms at all.
Addendum: According to a local physician, if a tick has been feeding for less than 24 hours, the bite does not have to be seen by a physician at all. Remove the tick and continue on. The area may be red and sore, but will eventually go away.
5) “Why was I prescribed only a single dose of antibiotics?” or “Why was I prescribed such a long regimen of antibiotics?”
The quick answer to this question is “it depends on the timing, and on whether or not you have symptoms of lyme disease”.
There are two regimens prescribed for a tick bite, one is a short single dose regimen, and another is a long regimen up to 3 weeks. Why is there this difference?
The shorter course of antibiotics prescribed when someone has found a tick, does not have any symptoms, and if four of the following criteria are met:
The tick is identified as a blacklegged tick, and is estimated to have been attached for 36 or more hours.
The antibiotic dose will need to be started within 72 hours after the tick has been removed.
The rate of Lyme disease is more than 20% (which is most likely true in the Brighton area)
The patient is able to take Doxycycline (ie: The patient is not allergic to doxycycline, is not pregnant, and is older than 8 years.)
The treatment is usually 200mg of Doxycycline (2 tablets of 100mg tablets or capsules) as a single dose.This is to prevent lyme disease and not necessarily to treat.
Some people are prescribed antibiotics up to 3 weeks. This regimen is prescribed to treat Lyme disease for people who have symptoms of lyme disease. These regimens typically last up to 3 weeks, and include antibiotics such as doxycycline, amoxicillin, or cefuroxime.
This is why it is important to hold on to the tick to allow the physician to confirm that it is indeed a tick. It is also important to note how long the tick has been on the skin, and to have a physician assess you immediately, as a single dose of antibiotic can only be prescribed 72 hours after the tick has been removed.
6) “Why didn’t the physician send the tick away for testing?”
Ticks are not sent away to be tested for lyme disease to help diagnose whether or not you have Lyme disease, they are sent away so that Ontario government can understand how ticks have spread, and also to estimate tick’s risk to humans. Depending on its prevalence and policy of local public health unit, some physicians may see it not necessary to send these ticks off to have them assessed.
TAKE HOME POINTS:
If you find a tick remove it with tweezers, pull away from the skin. Try to remove the entire tick. If you cannot remove the entire tick simply clean the area. What remains in the skin will eventually fall out.
See a physician as soon as possible after the tick has been removed.
Always save the tick, the physician may use it confirm that it is a black legged tick.
Antibiotic regimens depends on when and where you were bitten.
Prevent tick bites by minimizing your time in wooded areas (although Brighton is basically a wooded area). Cover up any exposed skin while in wooded areas. If you are going to be in a wooded area use bug repellant with at least 25% DEET for individuals older than 12 years old or 10% DEET for individuals 2 to 12 years old.
Needham, G.R. (1985). Evaluation of Five Popular Methods for Tick Removal. Pediatrics. 75(6)
Gammons,M., Salam,G (2002). Tick Removal. American Family Physician. 66(4),643-646.
Onyett, H. (2014). Preventing Mosquitos and Tick Bites: A Canadian Update. Paediatric Child Health. 19(6), 326-328.
HQ Ontario (2018). Management of Tick Bites and Investigations of Early Localized Lyme Disease [pdf file]. Retrieved from https://www.hqontario.ca/Portals/0/documents/evidence/qs-clinical-guidance-lyme-disease-en.pdf
Government of Canada (2018) . For Health Professionals: Lyme Disease. Retrieved from https://www.canada.ca/en/public-health/services/diseases/lyme-disease/health-professionals-lyme-disease.html