What to do When You Get a Tick Bite
The best way to treat Lyme disease is to prevent it. Most people that suffer from chronic Lyme disease were either not diagnosed or treated properly at the onset of exposure. Through education, if more people are aware of actions they can take to prevent Lyme disease and co-infections, fewer people would suffer from the long-term effects.
Fortunately for northern Californians, U.C. Berkeley researcher Robert Lane, PhD. has been studying ticks in our area for over 40 years. His research has shown that ticks in northern California can be infected with Borrelia burgdorferi, the bacteria that causes Lyme disease, and other bacteria (co-infections). Dr. Lane’s research has also demonstrated ticks in northern California are active year-round.
A common practice when someone gets a tick bite is to have the tick for Lyme disease (borrelia). However, this poses some challenges, and patients end up not receiving the treatment they need to prevent tickborne infections. First, public health departments only test ticks for borrelia, but none of the other bacteria ticks can be infected with (co-infections). In addition, results often take days to a week to report and the patient misses an important window to initiate treatment
The Bay Area Lyme Foundation has funded a grant for a Northern Arizona University research lab to conduct tick testing. There is no charge for tick testing, and the lab will test for co-infections, however results take weeks to months to report. One benefit of sending your tick here for testing is researchers will be able to identify where ticks where collected what bacteria they are infected with. Click here for more information.
Should You be Treated After a Tick Bite
The majority of the patients we see have been chronically ill with debilitating symptoms for months to years. If tickborne infections are not properly diagnosed or properly treated early, people can develop severe symptoms that persist. Read more here. Initiating treatment right after a tick bite prevents bacteria from spreading to joints, organs and the central nervous system. Remember, the best way to treat Lyme disease is to prevent it!
A single 200mg dose of doxycycline has proven to not be sufficient for Lyme disease prophylaxis, and treatment for 20 days or less with antibiotics in someone with a “bullseye” rash has a high failure rate. In addition, studies have shown ticks can be carry multiple bacteria, some that would require different antibiotics, so you can see why up to 50% of people treated following a tick bite go on to develop chronic symptoms.
The International Lyme and Associated Disease Society (ILADS) has established Treatment Guidelines for tick bites, based on clinical studies which can be viewed here.
Since Lyme bacteria can exist inside of cells (intracellular), on cell walls or in cystic forms, multiple antibiotics are often used to treat bacteria in each location. In his 2017 book How Can I Get Better?, Richard Horowitz, MD offers the following protocol to treat acute Lyme disease in a patient with an erythema migrans (bullseye) rash with no systemic symptoms:
- Month one –plaquenil 200mg twice per day; doxycycline 100mg twice per day; metronidazole or tinidazole three times per week. In addition, natural agents to address biofilm forms of bacteria
- Month two – (treatment considered unless significant improvement from month one) Cell wall antibiotic such as cephalosporins or pennicillins; Cystic antibiotic such as plaquenil, sometimes combined with tinidazole or metronidazole; Intracellular antibiotics such as azithromycin or clarithromycin, or septra, rifampin and/or a tetracycline
This contrasts the historical approach of using doxycycline for 1-14 days to treat a tick bite.
Common Misconceptions About Lyme Disease
- Ticks need to be attached for 24-36 hours to transmit Lyme disease – this claim has not been substantiated, and evidence has shown that ticks can transmit infections in as little as a few hours.
- You need to develop a bullseye rash to have Lyme disease – although a bullseye rash is diagnostic of Lyme disease, few people develop this rash that go on to develop Lyme disease. In one study, only 17% of people who developed Lyme disease had a bullseye rash.