Oh joy: it's tick season again. Most outdoor activists will be aware of Lyme disease, and may know someone who has contracted the illness. In this article Cory Jones of First Aid Training Co-operative explains the symptoms and treatment, how to avoid getting bitten by ticks, and what to do if you have been.

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Lyme disease, a tick-borne illness caused by the Borrelia burgdorferi bacterium, has become a significant public health concern in many regions, particularly in the United States and Europe. As of 2025, advancements in vaccine development offer hope in combating this pervasive disease. Meanwhile, the best advice is to avoid getting bitten, and to check yourself regularly for ticks.

Origins and transmission of Lyme disease

First identified in Lyme, Connecticut, in 1975, Lyme disease is primarily transmitted through the bite of infected deer ticks (Ixodes scapularis). These ticks acquire the bacteria by feeding on infected animals, such as mice and deer, and can subsequently transmit it to humans. The disease has since spread across various continents, becoming the most common vector-borne disease in the Northern Hemisphere.

Not all ticks are infectious. Recent estimates state that between 5% and 15% of a local population of ticks may be carrying Lyme disease. This may also vary year to year. It is difficult to accurately quantify these figures since not all human cases are reported or treated and there is no active sampling of tick populations. It's best to be aware of the signs and symptoms and the risks involved in having an infected tick hitch-hike along with you on your outing!

Recognising the Signs of Lyme Disease

Early detection is crucial for effective treatment. Common symptoms include:

• Erythema migrans: A distinctive "bull's-eye" rash appearing at the site of the tick bite, typically within 3 to 30 days. This rash expands gradually and may reach up to 30 cm (12") in diameter.
• Flu-like symptoms: Fever, chills, fatigue, body aches, headaches, and swollen lymph nodes.
• Joint pain: Intermittent bouts of swelling and pain, particularly in large joints like the knees.
• Neurological issues: If untreated, Lyme disease can lead to facial palsy, meningitis, numbness or weakness in limbs, and impaired muscle movement.

What do ticks look like?

Tick sizes vary with the different stages in their lives from larvae, nymph and through to adult. 

The ticks causing concern in the UK are mainly the species Ixodes ricinis and have a 5 staged life cycle. Moving from one phase to another is done after a blood meal from a host. Larvae are very small, have 6 legs and are least likely to be infectious. At the nymph stage, they have 8 legs, are easier to spot, and are often called 'questing nymphs' as they roam around eager to find a blood meal. They are considered more likely to carry a pathogen. Adults are larger and the female is larger than the male. In the UK, their life cycle may take 2-3 years. As they feed on their host, their bodies bloat with the blood they have consumed.

Preventative Measures

To minimize the risk of tick-borne diseases:

• Avoid walking or sitting in long vegetation wherever possible
• Wear protective clothing: Long sleeves and trousers can reduce skin exposure. Tuck trousers into socks
• Use insect repellent: Apply repellents containing DEET to skin and clothing (take care it doesn't contact climbing gear or expensive shell clothing)
• Perform regular tick checks: After outdoor activities, thoroughly inspect your body and clothing for ticks
• Stay informed: Be aware of tick-borne diseases prevalent in your area and consider vaccinations if recommended

By staying vigilant and informed, individuals can significantly reduce their risk of contracting Lyme disease and other tick-borne illnesses.

Proper Tick Removal Methods

Prompt and correct removal of ticks reduces the risk of disease transmission. Steps include:

1. Use fine-tipped tweezers: Grasp the tick as close to the skin's surface as possible. Steady upward pull: Avoid twisting or jerking to prevent mouth parts from breaking off and remaining in the skin
2. Alternatively, use a tick removal tool such as the O'Tom Tick Twister (as directed by manufacturer)
3. After removal, clean the bite area and your hands with rubbing alcohol, iodine scrub, or soap and water
4. Dispose of the tick: Submerge it in alcohol, place it in a sealed bag, crush it, or flush it down the toilet
5. Check the rest of your body for other ticks
6. Monitor the site for any rash that may appear
7. Monitor your health and be alert to any other symptoms, remembering signs of Lyme disease may take several weeks to become apparent.

A note on 'traditional' methods of tick removal. Fingernails, sun cream, alcohol, Vaseline, matches and cigarette ends are not effective methods of removing or killing a tick in situ. They only stress the tick into digging deeper, vomiting more saliva and increasing the potential for transmitting any infection.

Consulting a Doctor

If bitten by a tick or experiencing symptoms suggestive of Lyme disease:

• Inform your GP: Provide details about the tick bite, including when and where it occurred.
• Describe symptoms: Note any rashes, flu-like symptoms or neurological changes.
• Discuss exposure risks: Mention recent activities in wooded or grassy areas where ticks are prevalent.

If presented early, a treatment of the antibiotic Doxycycline will usually be prescribed and most people respond well to this with no further symptoms developing. Beyond this stage, or if attendance at your doctor is delayed, antibiotics and/or blood tests may be given or symptoms dealt with other appropriate treatments.

Blood tests at an early stage are not always reliable as the test detects the antibodies in your system and these take time to build up enough to be detectable. This is why early blood tests will often give a 'false negative' result. Blood tests later in the progress of the disease are more reliable – but you don't want to wait for that!

Early diagnosis and treatment with antibiotics are crucial to prevent the progression of the disease.

Lyme Disease Vaccination

As of July 2024, Pfizer and Valneva have announced the completion of the primary vaccination series for their Phase 3 trial, "Vaccine Against Lyme for Outdoor Recreationists" (VALOR). Participants in the study will be monitored for Lyme disease cases until the end of the 2025 season, with regulatory submissions anticipated in 2026. This new vaccine aims to provide comprehensive protection against the most common strains of the bacteria in both the U.S. and Europe.

A special note on Tick-Borne Encephalitis (TBE)

Tick-borne encephalitis is another serious viral infection transmitted by ticks, affecting the central nervous system. Symptoms range from mild flu-like signs to severe neurological complications such as meningitis or encephalitis. Preventative measures include vaccination and effective tick-bite prevention strategies as for Lyme disease. Cases of TBE have been detected in the UK without patients having travelled abroad, indicating local transmission. Between 2015 and 2023, 21 cases were identified, with a significant increase observed in 2022-2023. This underscores the importance of considering TBE in diagnoses of unexplained encephalitis, even in regions previously deemed low-risk.

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About the Author

Cory Jones has been an International Mountain Leader for two decades and is a wilderness first aid trainer. He is a founder member of First Aid Training Co-operative which runs outdoor and wilderness first aid courses globally.

Further resources

For more advice, check out the charity Lyme Disease UK