I’ve been bitten by a deer tick! What do I do?
I don’t think anyone enjoys sending or receiving this message.
The official IDSA answer to this question is to take 200 mg of Doxycycline 1 dose once and you have no problems. I’ve discussed this treatment strategy elsewhere. For this blog I’ll recap with this piece of info. The study that looked at doxy 200 mg 1 dose once only determined it stops the rash, it never determined if it stops Lyme Disease. A few people may have even gotten Lyme Disease during the study!
My answer to this question is not the same as the IDSA guidelines. I believe more in a proactive solution as acute Borrelia is much easier to treat than chronic Borrelia.
Deer ticks may or may not contain Borrelia, which is the causative agent of Lyme disease. It’s a risk to take antibiotics or not take antibiotics. It’s really a gamble. The gamble taking them is that antibiotics have side effects and can cause people serious damage. If the tick didn’t have Borrelia then that risk isn’t worth it.
The risk of not taking antibiotics is that there could have been Borrelia or other infections in that tick and you’re just letting it grow and duplicate while you wait for an answer.
This is entirely a judgement call. The IDSA guidelines do not agree with this being a judgement call. The IDSA guidelines are no treatment if less than 24 hour attachment. 1 dose of doxy 200 mg once if the tick was on for 24 hours or more.
Please take these steps with your new deer tick and the bite.
- Make sure it’s a deer tick.
- Ascertain how long it’s been on. I would suggest following this protocol if it’s been more than 4 hours or you aren’t sure. You can still follow this protocol if it’s attached for less than 4 hours. The debate about how long it takes to transmit Borrelia is hot. The CDC says it takes at least 24 hours. Anecdotal evidence has the transmission time much shorter.
- Get the tick off you ask quickly as possible, hopefully in a manner that gets the whole tick out without much trauma to you or squeezing of the ticks belly.
- Put the deer tick in a zip lock bag with a wrung out wet cotton ball.
- Test the tick. Umass extension tests ticks every day, their turn around time is very quick. It may even be fast enough that you have a result before you have any symptoms including the rash.. Igenex has a bit slower turn around but they offer more information. TIC-KIT is a prepaid kit that tests for multiple organisms and takes a little longer, but is far less expensive for multiple organisms. We have TIC-KITs in the office. I suggest UMASS extention if you need the report as quickly as possible! See the links at the bottom for the lab requisitions for tick testing. Sometimes a hospital or IDSA person may tell you, you can’t or shouldn’t test the tick. I disagree. Test the tick please. At least save it so I can convince you to test it later.
- Decide if you want to be on antibiotics while you wait. The longer the tick is on you, the more I suggest being on antibiotics while you wait. Since you aren’t certain if that tick had Borrelia, I tend to put people on lower dose antibiotics while waiting for the tick test to return. If the tick is positive for Borrelia I increase the antibiotic dose and suggest a treatment time of 2-3 months, following ILADS guidelines. Antibiotics should start within a few days of the bite. The sooner the better.
- I won’t prescribe antibiotics just from hearing you got a tick bite. We must speak. I need to know details, such as your antibiotic sensitivity, other meds, etc. If it’s the weekend and I get your message I will try to contact you. If it’s the work week, I’ll work to get you in ASAP. There is practically no chance I will respond to your requests over the weekend if you aren’t an established patient.
- You do have a choice of not starting antibiotics while you wait for the tick results. Lets say you got bitten on Sunday and you overnight the tick on Monday to Umass on Tuesday. You’ll have a response by Friday. That’s 5 days wait. You may choose to wait it out instead of taking antibiotics.
- An alternative to antibiotics, during the time waiting for test results, would be herbal treatment. I think the zhang formula, samento, teasel, and other herbs are appropriate for this time period. I would still suggest adding antibiotics if the test came back positive for Borrelia in the tick.
This one is the best choice for quick turn around.
We have tic-kits in stock. This test gives you the best price on multiple organisms and species. They say it can take up to 2 weeks, but often is resulted within 1 week. The speed isn’t as fast as UMASS Tick Report, but it’s a package deal for less.
(Igenex turnaround is about 2-3 weeks)
The link above should trigger a .pdf download to your computer with the form to submit the test. If you can not get that .pdf, you can go download it yourself from Igenex website.
When you are on the website, you can then click on the left hand column
Form and sample requirement
Test request forms
Tick Test Request form
There are other tick testing companies out there. If you want me to add your company, please send me an email and ask.
I’m fine with other companies testing, what I request is that you do the testing instead of guessing or waiting for symptoms. Not everyone gets the rash. The organism is very slow growing so symptom lag time could be months to a year! You may not even be able to relate the bite to your symptoms 6 months later and then you’re going to have a very hard time if you don’t recognize the infection or the blood testing isn’t helpful for you.
Hope this help you decide what to do.
Dr. Steve Clark, N.D.