I HAVE A TICK ATTACHED! WHAT DO I DO NOW??
Prompt, careful tick removal is very important in not causing accidental transmission of bacteria from the tick to the host. Tick removal instructions can be found at www.ilads.org/lyme/what-to-do-if-bit-by-tick.php
Should I test the tick?
If you have the tick available, it is best to test it. In the long run, this may save you time, money and your health. I have tick testing kits available in my office that test for the four most common disease-causing microbes found in ticks: Borrelia, Bartonella, Babesia and Ehrlichia/anaplamsa. These tests use state of the art, PCR (polymerase chain reaction) testing and cost $50 to test all 4 microbes. More information about the kits is available at www.tic-kit.com.
There are other labs around the country that will test the ticks for a fee, including IGenex, and there are others you can find by doing a Google search.
If the tick is negative for the above infections, there is a possibility that the infection was present in the tick, but that the test was not sensitive enough to pick it up. If the tick tests positive, it does not mean you have acquired the disease, but may heighten your vigilance if you are taking the ‘watch and wait’ approach to treatment.
Do I need to be treated with antibiotics?
It is important to get prompt treatment if any of the following symptoms occur in the first week or so after a tick bite: a rash of any kind (more will be said below), flu-like symptoms, fever, achy or swollen joints, headache, dizziness or sudden onset of fatigue or Bell’s palsy.
If you do not have any symptoms during the first week post tick-bite, there are different approaches you can take when deciding whether or not to be treated prophylactically for Lyme disease. One way, is watching and waiting. In this approach, it is important to be educated about the Lyme disease symptoms and the other co-infections. I agree with this approach, especially when a tick is being tested. Lyme disease symptoms (and co-infections) are varied. A good assessment tool can be found at www.cangetbetter.com/symptom-list
An additional approach is prophylactic treatment. Prophylactic treatment can be done with herbal medicine, drainage (or homeopathic) therapies or with prescription antibiotics. I use all of these options in my practice. Which ones to use depend on many factors including symptoms, prior exposure to tick-borne disease and the overall health of the individual.
Doctors who follow the ILADS guidelines for tick bites will differ in their approach to treatment. ILADS guidelines can be found at www.ilads.org/lyme/treatment-guideline.php
Some considerations for determining whether to treat for a tick bite include:
Is this a Deer tick (Ixodes Scapularis or black-legged tick) and does it matter?
There are a variety of tick species that carry various diseases, including other types of Borrelia infections. The number of infections being identified as being transmitted from ticks is changing as we have better identification techniques for these infections. Here is some information about ticks and the infections they carry www.danielcameronmd.com/about-ticks/
Was the tick attached for longer than 24 hours?
There are reports of transmission of Lyme disease from a tick to a human in as little as 45 minutes. When various sources of information have been compiled, reports on the time of transmission ranges from 45 minutes to up to 72 hours. Since no one can agree on how long it takes for transmission, depending on the source, you will get differing views on who needs treatment.
Not all ticks carry infection. It is very difficult to know what infections a specific tick carries. Testing has limitations. We know that the longer the tick is attached the higher the risk of disease transmission from an infected tick, though some other tick borne diseases may be transmitted earlier than Lyme disease. Obvious engorgement of the tick indicates a sufficiently long attachment for infection to be transmitted, but some engorgement can occur before it is visible to the naked eye. Since Borrelia, the bacteria that causes Lyme is found in the saliva of the ticks, it has been proposed that transmission can occur once the tick is attached, before it even begins to feed.
Was the tick removed easily with all identifiable parts intact?
Squeezing or damaging the tick body, or annoying the tick with applied substances increases the risk of bacterial transmission, and may increase the need for treatment. Leaving mouth parts in the wound does not increase bacterial transmission, but may cause a local infection. Ideally, you would like to have a live, active tick after removal.
How do I know if a rash is Lyme related?
When there is a single, small, eraser sized red area at the site of the tick bite in the first 24 hours, this usually indicates a local reaction to the tick bite and is not considered an Erythema Migrans, or bulls-eye rash. If there is any other kind of rash, draw an ink line around the rash and check in the following days to see if the rash increases beyond the borders of the line. The hallmark rash of Lyme disease is a red, expanding rash. If there is such a rash present, this IS Lyme disease and must be treated with a full course of antibiotic therapy. Even though a bull’s eye rash does indicate an infection with Lyme, other rashes do not indicate you do not have Lyme. Lyme rashes can occur localized to the area of the bite or at other areas on the body. I have seen many patients with various rashes. Another point about rashes is that only about 40-50% of people with Lyme disease had a rash. Not having a rash at all does not indicate you do not have Lyme disease. We cannot rely on seeing the rash as necessary for the diagnosis of Lyme disease.
Should I get tested for Lyme disease (or co-infections)?
Test results for Lyme disease are unlikely to be positive until about 4 weeks AFTER the known tick bite. It takes our bodies that long to mount a measurable antibody response which is necessary to have a positive Western Blot (WB) test result. There are problems with our current 2 tier testing methods, but the WB tends to be more reliable than the ELISA. The WB was developed for surveillance purposes, but is now used for diagnosis in many instances. WB testing is available from many labs. The testing labs will differ in the sensitivity of the testing. I do testing from various labs, but mainly use Igenex, in California.
I had a test and it was negative, could Lyme disease or another tick-borne infection be causing my symptoms?
The simple answer is yes! If you live in a tick endemic area or have visited one, it is possible you have contracted a tick-borne infection. Only about 40% of Lyme patients remember having a tick bite. If you had a test and it was negative, there are various reasons this may occur. One reason is the test may have been done too early, before your body mounted an immune response. Second, some tests are not as sensitive as other tests. Third, Lyme disease can suppress the immune system, preventing a strong immune response. Since the WB test is testing an immune response, it may be negative. If you suspect you have a tick-borne infection, but are not testing positive, contact ILADS to find a Lyme literate doctor.
Is one (or 2 or 3) doses of Doxycycline the answer?
There is no evidence that one dose of doxycycline is an effective treatment for Lyme disease or that it prevents disease. However, one dose of Doxycycline may prevent an antibody response, may prevent the rash from appearing, and may prevent tests from showing up positive. Opting to ‘watch and wait’ may be the better choice.