Every few months, Jennifer Crystal devotes a column to answering your questions. Do you have a question for Jennifer? If so, email her at firstname.lastname@example.org.
Now that tick season is upon us, friends ask me what to do when they find an embedded tick. What should I tell them?
While this question seems like it should have a simple answer, people probably get conflicting information from the internet and even from physicians about what they should do if they find a tick. This is because there is debate about how long a tick needs to be attached to a human or pet in order to transmit the bacteria that causes Lyme disease. The old standard of 36-48 hours doesn’t necessarily apply anymore, now that we know that ticks can transmit bacteria faster if they were already partially fed before biting you, and that some tick-borne diseases can be transmitted much faster than Lyme disease—Powassan virus in as little as 15 minutes.
There are two general rules of thumb that I always tell people: the first is that the longer a tick is attached, the greater chance it has of transmitting pathogens. And unless you see the tick bite you, you can’t really know how long it’s been attached. If you notice it after a long day of hiking, you don’t know if it bit you early in the morning, or just as you were leaving. What if you don’t notice it until the next day, after you’ve done some gardening and walked through the grass? If a tick is engorged, you know it has been feeding, but it can be hard to pinpoint exactly where and when it became attached to you, which makes the certain-number-of-hours recommendation moot.
This leads to my second rule of thumb: with Lyme and other tick-borne diseases, it is always better to be safe than sorry. I tell people that if they find a tick, they should call their doctor and get right on antibiotics. Even if those antibiotics end up being prophylactic, it is safer than the alternative—finding out weeks, months or years later that they’re sick with Lyme and possibly with co-infections, too—and then needing far more extensive treatment than the initial antibiotic course. Waiting for test results (often faulty, especially early in infection), waiting for a rash (which doesn’t appear in up to 30% of people with Lyme), or waiting for other symptoms (different for everyone), is a dangerous approach to Lyme disease. (For more information, see my blog post “The Danger of ‘Waiting and Seeing’ with Lyme Disease”).
The next question is, how long a course of prophylactic antibiotics should you take? The Infectious Diseases Society of America (IDSA) recommendation of a single dose of prophylactic doxycycline is based on one study that showed good efficacy in preventing Lyme rash, but as we’ve established, not everyone with Lyme disease gets a rash. The International Lyme and Associated Diseases Society (ILADS) recommends a 10-20 day course of antibiotics. For me personally, I’d rather have the coverage of a full treatment course that is used for actual Lyme infection, rather than take my chances that a single dose will keep me safe. Each person needs to make their own decision with their doctor, but it’s important that decision be an informed one!
Do other tick-borne diseases have the same treatment as Lyme disease?
This is a great follow-up question to the first, because some people might think, “Well, if I’m taking antibiotics for Lyme disease, then I’ve got other tick-borne diseases covered.” That’s true for some co-infections, but not for all, so this, too, is dangerous thinking. Some co-infections like anaplasmosis and ehrlichiosis are treated with the same antibiotic as Lyme disease, but the length of treatment might be different. Other tick-borne diseases like babesiosis, which is a parasite that infects the red blood cells, require completely different treatment. And still another co-infection, bartonellosis, needs more urgent research for better treatments (learn more about GLA’s Bartonella Discovery Program here). I always tell people, “If you’re being treated for Lyme disease and don’t know you have babesiosis, you’re only fighting half the battle.” If you find a tick attached to you, it’s imperative that you talk to your doctor about other tick-borne diseases, not just Lyme, and know the signs of them (see “Common Tick-Borne Diseases”).
The Bartonella Discovery Program:
GLA is currently fundraising for The Bartonella Discovery Program, a research project bringing together some of the top researchers world-wide who are experts on Bartonellosis. These researchers will learn more about the bacteria and which treatments are most likely to cure patients like Beth, who are suffering from Bartonellosis.
None of the work GLA has accomplished would be possible without your support. To learn more and fund this project, click the button below:
Opinions expressed by contributors are their own. Jennifer Crystal is a writer and educator in Boston. Her work has appeared in local and national publications including Harvard Health Publishing and The Boston Globe. As a GLA columnist for over six years, her work on GLA.org has received mention in publications such as The New Yorker, weatherchannel.com, CQ Researcher, and ProHealth.com. Jennifer is a patient advocate who has dealt with chronic illness, including Lyme and other tick-borne infections. Her memoir about her medical journey is forthcoming. Contact her via email below.