I was working outside on an early spring day, clearing brush and tidying up. In the late afternoon I noticed a small bump on my neck and didn’t pay attention. But when I took a shower I noticed a black speck, perhaps the size of a quarter of a grain of rice with wiggling legs. I removed it, mangling it in the process, put it in a zip lock bag and rubbed the spot with alcohol.
Did I do the right thing? Was the tick of the Ixodes variety that carries Lyme disease or another kind? Should I have it tested, see my doctor and take doxycycline?
l reviewed current medical recommendations and talked with Jim Dill, past head of the University of Maine’s tick lab and the state’s reigning tick expert. The lab has an excellent informational web site at ticks.umaine.edu.
There are 15 varieties of ticks reported in Maine but only Ixodes scapularis — the black-legged tick, formerly called deer tick — transmits Lyme disease.
They hang out on low-lying bushes, grass and other vegetation starting in the spring, patiently waiting to grab a passer-by — a person or an animal. They attach with tiny claws and a kind of superglue, and inject both an anesthetic and an anticoagulant so you don’t feel them sucking your blood. Anyone working or playing in a wooded area, or an area where grassy and wooded areas meet, is at risk.
Nymphs, which begin to be active in the spring, are tiny, round black spots. They’re 1/16 inch in diameter — the size of Ben Franklin’s pupil on a $100 bill — highly infectious and easily overlooked. By autumn, they have grown to adulthood, still infectious but more easily recognized and removed.
Prevention is always the best option, Dill said.
If you are going to be outside, wear light-colored clothing, spray it with permethrin or other repellants, tuck your pants into your socks, and most importantly examine yourself carefully at the end of the day. Examine yourself again the next morning because nymphs may have engorged and become more visible. Get help if needed. This is no time for modesty. Be sure to check your hair, groin and armpits.
What to consider if you have been bitten
— Is it an Ixodes, a dog tick or something else? Identification of anything other than a dog tick is fiendishly difficult for an amateur. You can try, and there are excellent photos on UMaine’s tick website and elsewhere. If you have any doubt, however, put the tick in a zip lock bag and send it to the tick lab for identification at no cost. It costs $15 to have the tick tested for pathogens, may take three or seven days and will not change initial treatment.
— Is it firmly attached? If not and it is just crawling around, the tick has not begun to feed and you will not get infected.
— If it is attached, how long has it likely been attached? This is often difficult to determine but it helps to remember the last time you were in the woods or a grassy area. Infectious agents are not released from the tick’s gut until it has started feeding. The time it takes for a tick to transmit disease varies: it is exceedingly rare in less than 12 hours, rare in less than 24 hours and uncommon in less than 48 hours. In other words, a tick generally has to be attached to you for a while before it’s most likely to transmit disease.
What to do next
Remove the tick by grasping it as close to the skin as possible using either tweezers, a tick spoon or other commercial tick extraction device. If one of those tools is not available, use paper or cloth to protect your hands during extraction because the tick’s mouth parts may contain the infectious agent.
Pull straight up, gently but firmly, and don’t squeeze or puncture the body. Be patient. It may take several minutes to persuade the tick that you are not happy with its presence. If you happen to leave some parts in the skin, wait for them to fall out spontaneously; digging them out may result in soft tissue infection.
Dill advises against using petroleum jelly, finger nail polish, ethyl alcohol, a hot match or anything else. These strategies increase the likelihood that a tick will vomit and leave infection behind.
Wash your hands when you’re done.
Prophylaxis or preventative treatment is recommended if: (1) the tick is likely an Ixodes, (2) you live in a place where ticks have been reported (i.e. everywhere in Maine), (3) the tick has been attached for more than 12 hours (based on the degree of engorgement or time of exposure) and (4) if you can start treatment within 72 hours.
Your health care provider will have to balance the risk of a single dose of doxycycline against the risk of potential Lyme disease. The side effects of a single dose of doxycycline are uncommon and mild (nausea and vomiting), though children and pregnant women require special consideration.
Lab tests do not help at this early stage.
The problem is, of course, that life is never simple. You can remove one tick but another may be hiding elsewhere on your body. An undiscovered tick may feed for four to five days and fall off unrecognized. Besides Lyme, other tick-borne diseases are becoming more common.
Of the 6,499 specimens submitted to the UMaine Tick Lab in 2021, 42 percent were positive for Lyme, 12 percent for anaplasmosis and 10 percent for babesiosis. The lab does not routinely test for Rocky Mountain spotted fever, Miyamoto and Powassan virus, which are less common.
If a tick bit you unnoticed, the first sign of Lyme disease for 70 percent of people — or, in Maine for some reason, only 50 percent — may be a “bull’s eye” rash that appears anywhere on your body within the first 30 days. The treatment of established Lyme disease — as opposed to preventive treatment — can be complex and is best handled by your doctor as soon as possible. Err on the side of caution!
So, did I treat my tick bite appropriately?
I should have been gentler in dislodging the tick. Some body parts that stuck to me are just now beginning to fall off. Because the tick had been on me for only a short time, I chose not to take doxycycline.