Ticks are rarely detected in the early stages of feeding because their bites are painless. In some bitten individuals, the tick bite will itch after a day or two, but in many cases, ticks, especially larvae or nymphs, may feed to repletion undetected. The longer the tick feeds, the more likely it is to transmit B. burgdorferi, the organism responsible for Lyme borreliosis, but also other tick-borne diseases, so it is important to remove the tick as soon as it is detected. If detected within the first hours of feeding, the risk of transmission is much reduced. After spending time in nature, regular inspection of the skin for attached ticks and prompt removal are the best preventive measures. However, it is also important to remember that the majority of ticks are not infected!
Numerous studies have been conducted on methods of tick removal (Kahl et al., 1998. Zentralblatt für Bakteriologie, 287: 41-52), but despite many anecdotal and popular press accounts of other methods, the safest and most reliable method still appears to consist of the direct use of forceps (tweezers). The tick should be grasped as close to the skin as possible with a blunt or curved pair of forceps and removed by steady vertical traction, without twisting or squeezing the tick. Specialist tick removal cards or devices can also be used. There is a possibility that fragments of the mouthparts may be left in the skin, but these are so small that they very rarely cause any problems, especially if the skin is disinfected before and after the procedure.
The use of chemical and physical methods including petroleum jelly, alcohols, nail varnish, oils and hot matches have proved ineffective, and in some cases may cause serious damage to the skin. It has been suggested that application of chemicals, heat etc. may increase the risk of infection by causing increased salivation, though this was not found to be the case in the only study that has addressed this aspect systematically (Kahl et al., 1998. Zentralblatt für Bakteriologie, 287: 41-52). The main argument against most of these approaches is that they all involve some delay. Immediate removal of the feeding tick on detection is the best defence.
SUMMARY
Remove the tick as soon as possible by grasping it with a pair of tweezers at the place where the tick’s mouthparts are attached to the skin. Apply gentle pressure and pull upwards firmly and steadily. Clean the area around the bite with antiseptic disinfectant.
DO NOT:
- Panic.
- Crush the tick’s body.
- Try to burn the tick off.
- Apply petroleum jelly, nail polish or any other chemical (other than antiseptic).
DO:
- Use a pair of tweezers or specialist tick removal card/device*
- Cleanse bite site with antiseptic before and after removal.
- Wash hands afterwards.
*If a pair of tweezers is unavailable, use a cotton thread rather than delay. Tie a single thread loop around the tick’s mouthparts, as close to the skin as possible, then pull gently upwards and outwards.
Post bite
If the tick-bite area does not heal promptly or becomes painful, consult a doctor, as a local infection caused by other bacteria may be present. For Lyme borreliosis, continue to check for a spreading red patch, especially one that appears between 3 and 30 days after removal of the tick. If symptoms develop in the days or weeks following the bite, a doctor should be consulted as soon as possible. The risk of developing Lyme borreliosis from a tick bite is small, even in heavily infested areas. Prophylactic treatment with antibiotics in Europe is not advised.
Kahl O, Janetzki-Mittmann C, Gray JS, Jonas R, Stein J, de Boer R. Risk of Infection with Borrelia burgdorferi sense lato for a Host in Relation to the Duration of Nymphal Ixodes ricinus Feeding and the Method of Tick Removal. Zentralblatt für Bakteriol. 1998;287: 41–52. doi:10.1016/S0934-8840(98)80142-4