A tick perched on top of a blade of grass

Tick removal and understanding Lyme Disease

Updated May, 2021

Why should we be concerned about ticks?

Ticks are small arachnids that feed on the blood of birds and mammals, including humans. They may carry a range of pathogens (bacteria, viruses, protozoans etc) that are then transmitted to the host when they bite. It is important to remove an attached tick as soon as possible. It is also important to remove the whole tick on one piece to avoid any pathogen being disgorged into your bloodstream during removal.

How do you remove a tick safely?

Use a tick removal tool such as tick twisters, tick cards or fine point tweezers. Do not use domestic or utility tool tweezers with broad tips as they might decapitate the tick and it’s important to remove the whole tick in the process. You can watch an NHS video on how to remove ticks.

A selection of tick removal tools including twisters, cards and tweezers
Various tick removal tools

Using a tick twister to remove a tick:

Tick Twisters are quick and easy to use. They work by forcing the the tick to let go of you and are very successful at getting the whole tick off in one go.

  • Select the right size of Tick Twister for the tick
  • Slide the Twister under the side of the tick
  • Slowly twist / turn the tool and gently lift the tick off
A selection of different sized tick twister tools
Tick twisters come in different sizes to remove different sizes of ticks.

An illustration of a tick twister sliding under a tick then being twisted and lifted up to remove the tick.
Sliding the tick twister alongside and under the tick, then twisting and lifting the tool slowly, will remove it.

Using a tick card to remove a tick:

Tick cards are easy to carry with you and have small and medium sized slots in them to ‘flick’ embedded tick off your skin.

  • Lay the card flat on your skin alongside the tick
  • Slide the appropriate size of card slot under the side of the tick
  • Lever the card up to ‘flick’ the tick off, gently
  • Don’t flick it too hard else it might just land on another part of your body or someone else!

Using fine point tweezers to remove a tick:

Tweezers can be a bit fiddly to use as they sometimes pinch the skin as well. Always use fine point tweezers. Don’t use domestic or utility tool tweezers with a broad point as they might decapitate the head and leave it in your skin.

  • Grasp the tick with the tweezers where the mouth meets the skin
  • Slowly and steadily pull the tick up and away from your skin
Tick removal with tweezers showing how to grasp the tick where it is attached to the skin, then lifting it off.
Grasp the tick and lift it UP and away from your skin

After you’ve removed a tick:

  • Clean the wound area with a medi-wipe or soap and water
  • Monitor the site for any rash that may appear
  • Check the rest of your body for other ticks
  • Put the tick on a hard surface and crush it using the end of the tick removal tool (unless you want to keep it for evidence or testing)
  • Clean the tick removal tool with a medi-wipe ready for future use

A note on ‘traditional’ methods of tick removal!…..

Fingernails, alcohols, Vaseline, matches and cigarette ends are not effective methods of removing or killing a tick in situ. They only stress the tick into regurgitating more saliva and hence increase the potential for infection transmission.

What do ticks look like?

A finger with 4 different sized ticks on it from nymph through larvae to adult
Tick sizes vary with the different stages in their lives.

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, 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.

Will I feel them bite me? (Ticks don’t tickle!)

Ticks inject an anti-coagulant into you which acts like an anaesthetic on your skin and helps them feed on your blood. You most likely won’t feel them during this process which is why it’s important to check yourself regularly when out and about. They are most active between spring and autumn but can be found throughout the year. They latch on to you from alighting from grasses, bushes and dropping on you from low tree branches. They move to a dark, moist place on your body and latch on with their mouths – in your armpits, stomach, groin, hairline, behind the ears or knees and between the toes.

Why are ticks dangerous?

Ticks may be carriers of bacterial, viral or other pathogens that they have picked up from other hosts, i.e local wildlife. When they bite into you, they regurgitate their stomach contents whilst feeding. If they have picked up a pathogen, they will infect your blood with it whilst attached. It is therefore very important to get the tick removed as soon as spotted. They may stay attached for up to 36 hours increasing the risk of infection throughout that time.

Not all ticks are infectious. Estimates vary from area to area and season to season but it is generally thought that 5-10% of ticks in the UK may be carrying infections harmful to humans. However, in some areas this figure is higher. These ‘hot spots’ are often the subject of an NHS or Lyme Disease charity campaign to raise awareness of Lyme Disease for the public and the medical professions.

Ticks are also found throughout Europe, Australia and in America. The term Lyme Disease originated from the town of Old Lyme in Connecticut, USA, where there was an outbreak of arthritis linked back to ticks.

What is Lyme Disease?

The most well known tick-borne disease is Lyme Disease and is caused by the bacteria Borrelia burgdorferi which is carried in the stomach of an infected tick. Lyme Disease can be a lifestyle-changing disease with some serious long term health implications if not detected and treated early. More and more people are diagnosed with the disease but many more may go undetected. In Scotland, there are more than 200 cases reported per year.

What are the signs and symptoms of Lyme Disease?

A red skin rash in the shape of a bullseye target
A bullseye shaped rash is typical of Lyme Disease – but doesn’t always appear like this initially.

Early signs – after a tick bite may be a rash that appears and usually forms into a ‘bulls-eye’ shape on the skin and is called Erythema migrans. This may appear between 2 – 40 days to first appear after the bite and it may grow over time. If you develop a rash, take a photo and mark the edge of the rash with a pen to monitor any change in size. Not all Lyme Disease rashes form into a bulls eye shape so don’t wait for it to do this!  Go to your GP or Out of Hours clinic as rash is a diagnostic sign of Lyme Disease and needs to be checked out by a medical professional. Antibiotics is the recommended treatment.

Longer term symptoms – Without immediate treatment or if that treatment is unsuccessful, further symptoms that may develop within 3 months and include flu-like symptoms, facial palsy, joint pain and heart problems. Longer term symptoms may include chronic fatigue, neurological and arthritic problems. The longer term infected persons immune system is over-worked and the patient feels very drained and exhausted. Neurotransmitters react to the disease by exhibiting heightened emotions, sensitivity to light and noise and light headedness when getting up or down.

How is Lyme Disease treated?

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 it detects the antibodies in your system and these take time to build up enough to be detected by the specific blood test. This is why early blood tests will often give a ‘false negative’ result. Blood tests later on in the progress of the disease are more reliable – but you don’t want to wait for that!

How can I reduce the risk of infection?

  • Be alert to the risk of ticks in an area and share this information with your walking group, friends and colleagues
  • Always have a tick removal tool handy whether you’re in the countryside or in the garden. Keep a set a t home, in the car and at your workplace if appropriate.
  • Keep to footpaths and avoid long grass and overhanging tree branches
  • Inspect yourself regularly whilst outdoors and when you get home. Have a buddy system in your group, family or workplace to inspect each other for ticks
  • Wear appropriate clothing in tick-infested areas – a long sleeved shirt, gaiters or trousers tucked into socks
  • Wear light coloured clothing as this may help you see ticks better
  • Use inspect repellent on your clothes and skin. Check repellents are suitable for children or pregnant women. You can also buy treatments for clothes that you regularly wear outdoors
  • Make sure you do not bring ticks home on your clothes or on your pets
Tucking your socks gives the ticks less access to your skin!
On hot days, shorts are great but be extra vigilant for ticks on your legs and higher up!

What other diseases do ticks carry?

Ticks carry other diseases based on the local pathogens they encounter in their many hosts. Although some of these are new to the UK, about 15% of the UK’s Lyme Disease cases come form people who have travelled overseas and picked up the disease there.

Tick-borne Encephalitis (TBE)  is a viral infection recently confirmed in the south of England (2020). This attacks the nervous system and can result in meningitis, brain inflammation and death. Patients who present early with first stage symptoms usually recover with the help of painkillers and anti-inflammatories. Patients who develop second stage symptoms require hospital treatment.

Tick-borne Babesiosis has also recently been diagnosed in patients in the south of England (2020). This is caused by a Babesia protozoan infection from the tick. The disease is rarely tested for by doctors and global levels are unknown. Several species of Babesia cause the disease and the signs and symptoms can be wide ranging. They include fever, fatigue, anaemia and nausea, symptoms that are common in many other illnesses.

Crimean-Congo Haemorragic Fever (CCHF). A viral infection that has no treatment and kills up to 40% of infected humans. This is a similar scale to Ebola or bubonic plague. Domestic animals such as sheep and cattle can maintain the CCHF virus at high levels and this means the potential for CCHF to expand into new regions like Europe is possible.

Sever Fever with Thrombocytopenia Syndrome (SFTS). Only identified in 2009, SFTS has sparked widespread concern throughout much of Asia. In Japan, 57 people have died of the disease since 2013. Signs of the disease can range in severity from relatively mild, such as fever and diarrhoea, to severe which can include organ failure. It is known to be carried by at least two tick species that are spread throughout the world including the UK.

Lyme Disease and Covid-19 – a comparison of symptoms:

With multiple symptoms, Lyme Disease and Covid-19 may cause some concern. This table, from Lyme Disease Action UK gives a quick check of the main early symptoms where “Yes” means fairly common but not in everyone. The darker red, the the most significant the symptom is in that disease.

A table showing the different symptoms of Covid-19 and Lyme Disease

FAQs:

Why are there more ticks around now?

Ticks can live in a wide range of habitats and have moved from grasslands and moorlands into parks and gardens. A combination of changes to our climate, increasing mobile human populations, increasing numbers of pets in households and habitat loss bringing wild animals in contact with urban areas has meant and increase in the spread of worldwide tick populations. Ticks can be killed off in a hard winter in the UK but these are less frequent now and therefore there is an increase in tick numbers surviving throughout the year.

Can you test a tick to see if it’s carrying Lyme Disease?

Yes. Due to the variable results of testing humans for Lyme Disease in its early stages, many folk opt to send their tick away to get tested. The results are generally returned within a few days. Lyme Disease Test Kits are available in most outdoor shops and with a discount code via our website.

Should I always carry a tick removal tool?

Yes, several. Keep them in all your first aid kits, at home and in the car, ready to use.

Have you found a tick and successfully removed it?

Good, look for more and be vigilant for signs of infection.

Remember, the benefits of outdoor recreation far far outweigh the risks – keeping active and healthy keeps your immune system in top condition in order to fight off any nasties!

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