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Erythema Migrans, Lyme disease, Ticks

Lyme Disease

Prevention is better than cure

Lyme disease was first described in 1975 in Old Lyme, Connecticut and is the commonest tick-borne illness in the Northern Hemisphere (about 65,000 cases in Europe each year). It is caused by a bacteria called Borrelia that is carried by ticks and transmitted to humans when they are bitten.

Ticks are tiny spider-like creatures that live in woodland or areas of long grass. They attach to the skin of birds and mammals, including humans, and feed on blood before dropping off after a few days.

Most ticks don’t carry Lyme disease, so being bitten doesn’t mean you’ll definitely get infected. The areas with the greatest risk are the southern counties of England and the Scottish Highlands. in areas popular for outdoor activities. Most cases occur in late spring early summer and Autumn, when people are most likely to be doing outdoor activities and camping.


Lyme disease can be quite difficult to diagnose as the symptoms are non-specific and mimic other illnesses.

The most common early symptom in about two-thirds of people is a circular red rash around the bite. This rash is called Erythema Migrans and looks like a ‘bullseye’ on a dartboard. It is usually about 15cm wide (but can be bigger or smaller), red and sometimes has raised edges. It usually appears within a couple of weeks of being bitten but can be delayed for up to 3 months. Around a third of patients also complain of flu like symptoms early on including fever, feeling shivery, headaches, joint pains and exhaustion.

If you don’t get treated early, a second stage can develop weeks or months later. These are caused by the infection spreading to other areas of the body. Joints, particularly the knee, get inflamed, swollen and painful. Weakness and numbness can develop die to inflamed nerves, in particular around the face. The heart can get affected causing chest pain, breathlessness, palpitations and inflammation of the tissues around the brain can lead to meningitis with a sever headache, stiff neck and sensitivity to light.

Some people experience longer term symptoms such as tiredness, aches and loss of energy which can last for many years. This is rare and doesn’t happen to everyone. It’s thought to be due to overactivity of the immune system rather than the infection itself, so can be very difficult to treat.


Like other insect borne diseases, the best way to prevent infection is to avoid getting bitten. Most tick bites are harmless as only a small proportion of ticks are infected. However, it’s important to be aware of the risk and to take sensible precautions in high risk areas, including:

  • keeping to footpaths and avoiding long grass when out walking
  • wearing appropriate clothing in tick-infested areas (a long-sleeved shirt and trousers tucked into your socks)
  • wearing light-coloured fabrics to help spot a tick on your clothes
  • using insect repellent on exposed skin
  • inspecting your skin for ticks, particularly at the end of the day. Check your head, neck, armpits, groin, and waistband and remove any ticks promptly
  • checking your children’s head and neck areas, including their scalp
  • making sure ticks aren’t brought home on your clothes
  • checking that pets do not bring ticks into your home in their fur

Diagnosis and treatment

Be vigilant. If you notice a tick on your skin, remove it with a pair of tweezers. Grasp the tick as close to the skin as possible and pulled upwards slowly and gently to try to remove the insect in one piece. Wash the skin with soap and water and apply antiseptic cream. Don’t use a lit cigarette end, a match head or alcohol or petroleum jelly to force the tick to let go.

If that works, you feel well and there’s no sign of a rash, then you don’t need antibiotics and nothing further needs to be done.

If you’ve been bitten by a tick (or could have been) and you develop a classic bullseye rash, you should be treated for Lyme disease. You don’t need any further investigations. Treatment involves a three week course or antibiotics such as amoxicillin or doxycycline.

The later stages of Lyme disease are difficult to diagnose. Blood tests can be carried out after a few weeks, when the body has started to mount an immune response. They sometimes need repeating if the first test is negative. If Lyme disease is diagnosed at a later stage, then the treatment is still antibiotics, although a longer course may be required.

Contact Bluezone if:

  • You’re concerned that you have, or may have, been bitten by a tick
  • You’ve noticed a tick on your skin and would like help removing it.
  • You’ve visited an area where there may be ticks and you experience flu-like symptoms or a circular rash on your skin.
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