What You Need to Know About Lyme Disease

And how NOT to get it 🪳

Jul 22, 2024

ICYMI 👉

Every summer I see a few cases of Lyme disease. This year is no different! Below is one of my patients who gave me permission to post this photo. She came in to see me complaining of flu-like symptoms—body aches, fever, fatigue. We hypothesized that she had COVID or influenza until I examined her skin and—voila!—there it was: the most perfect bullseye rash.

She didn’t need a nasal swab to test for viruses; she needed a course of oral doxycycline, and that was that. So, in honor of her and the great outdoors, today is all about Lyme disease.

What you need to know about Lyme, and how NOT to get it.

Lyme disease is a bacterial infection caused by Borrelia burgdorferi whose life-cycle requires a tick and a mammal to reproduce.

Spending time outdoors means time exposed to arachnids and insects. Ticks are a type of arachnid that are particularly vexing because they can transmit several infections including Lyme. Fortunately, only one species of tick carries Lyme and there are some very simple actions you can take to avoid getting it.

Which ticks can carry Lyme?

The black-legged tick (Ixodes), also known as the deer tick, is the only Lyme vector. So don’t sweat it with dog ticks. Even though it is called the deer tick, it can feed on many different mammals, from mice to bears. Personally, I don’t trust myself to correctly identify a black-legged tick, but if you keep the tick (as you should), you can upload a photo of it here and they will identify it for free.

Black-legged ticks are small (about the size of a sesame seed), but they become larger as they become engorged with blood from feeding on you (or on some other mammal). Nymphal ticks (i.e., babies) can be much smaller, so size is not that reliable for identifying black-legged ticks.

How can I enjoy the outdoors without risking a Lyme infection?

Lyme is actually quite easy to prevent. Here are three simple, and highly effective, things you can do:

Wear light-weight long pants and sleeves as well as real shoes and socks when spending time outdoors, particularly if you are going to be in grass, woods, hiking, etc. Tuck your pants into your socks. Looking nerdy for a few hours is worth avoiding Lyme disease. 🤓
Use a repellent on your clothes or skin. Most DEET-based products or oil of lemon eucalyptus (OLE) work on ticks as well as mosquitoes. For children, choose a less toxic repellent such as OLE and remember that permethrin-based products are approved only for use on clothing, not skin!

Most importantly, check for ticks thoroughly, as soon as you come inside or if you are camping, for example, and outside for long stretches, at least once per day.

I suspect this last action is where people slip up, because a thorough search will find any tick. Note that ticks love to hide where it is nice and warm so it is critical to check everywhere—between your toes, behind your ears, in your hair, on the back of your neck, behind your knees, in your groin, and in your armpits. These spots, particularly body creases like where your legs join your rear end or groin, are often overlooked. If you can’t see these spots well, ask a (close) friend/partner to have a look, or use your fingers to feel very slowly and carefully. Checking for ticks thoroughly should take you at least ten minutes. Don’t rush it. Make sure you are undressed. The best time is when you are getting in or out of the shower.

Here is my dear mother after the 4th of July weekend. A classic bullseye! Note that her rash went away after a few hours, so it was lucky that she caught it. (Also note that she gave me permission to post this photo.)

What to do if you find a tick

If you do find a tick on your body, take these simple steps:

If the tick is not attached (i.e., if you can just brush it off) and/or if the tick is walking around where you can see its head and legs, there is virtually no chance you are infected with Lyme. Whew! You are done. Go grab a snack.
If the tick is not attached to you but it is engorged, it’s possible that the tick bit you but already detached itself. If you have a mark on your skin I would be more suspicious that it bit you. In any event, I suggest saving the tick in a small container or in a sealed ziplock bag. Write on the bag (or container) the date and time you found it, and consider bringing it in to your doctor or health clinic for testing.

If the tick is attached to you, follow these directions to remove it. If you know when you think you picked it up, and it was within 24 hours of finding it, it is extremely unlikely that you will get Lyme disease. Nevertheless, after you have safely removed it, save it as described above and note the date and time you removed it as well as the date and time range you think you picked it up.
If the tick is attached to you and is engorged and you think it has been attached for more than 24 hours, you might receive post-exposure preventive treatment with a single dose of doxycycline if you were in a high-Lyme area.

If you find a tick, and you do not know how long it has been there, or you know it has been more than 24 hours, save it as described. You could see your provider to get tested, however it’s important to note that testing too soon—that is, before your body has has the change to produce antibodies—can give a false negative test. Alternatively, you could wait 30 days and if you have no symptoms, you are probably in the clear. The nuances here should always be discussed with your healthcare provider.
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What if I have symptoms (rash, fever, joint pain, headache, etc) and no known tick exposure?

Many people don’t notice tick bites, such that the exposure is never documented. So, if you have Lyme symptoms, be sure to see your provider promptly. You may need a blood test to detect antibodies to Lyme, however (as above), sometimes these tests reveal false negative if done too soon. Not to mention that a positive test only means you have been exposed at some point in time. So, in practice, it often makes sense to treat the patient with antibiotics even without a positive Lyme test if the clinical suspicion is high enough.

Also note that rashes, fevers, and systemic symptoms can be a result of myriad other non-tick-related illnesses (e.g., COVID, flu, other viral and non-viral infections, autoimmune conditions, medication effects) such that a thorough medical evaluation is always appropriate for these kinds of issues.

Can I get Lyme from my pet?

A pet cannot transmit Lyme to you by licking you or snuggling with you. However, ticks love pets even more than they love you (it’s the nice thick hair), so it is possible an infected tick that was on your pet can later bite you. Most commonly, ticks are on dogs because dogs romp in the grass, so you should check dogs as carefully as you check yourself, and use a flea and tick prevention product. Ticks on cats are rare because cats will groom themselves and remove them, but occasionally it happens especially if a cat is old or sick.

Can I get other infections from ticks?

There are a few other infections carried by ticks, depending on where you live, but all of them are way less common than Lyme. Several of them (anaplasmosis, Rocky Mountain Spotted Fever) respond to doxycycline, the same antibiotic usually given when Lyme is suspected, so it is rare to even test for them. If your symptoms do not get better with doxycycline treatment, and you have had a known multi-day tick exposure, your doctor might test you for other tick borne infections that require a different drug, such as babesiosis. However, this situation is extremely rare.

You can always send your tick in the ziplock bag to a tick identification lab (it’s usually free) and they can test it for various pathogens if your symptoms are not cleared up by doxycycline. If mailing it, the sooner the better.

The upshot

Time outdoors is the greatest balm for the soul, so don’t let ticks keep you inside! The steps outlined here will largely neutralize the possibility of a Lyme infection. Plus, if you do get Lyme, treatment is fairly straightforward for the vast majority of people.

Have you had Lyme? Are you a magnet for ticks? Tell me! I’m all ears.