Time for a refresher on ticks

A deer or blacked legged tick on a leaf

Tick-borne diseases like Lyme disease, anaplasmosis, and babesiosis are a serious health concern in New Hampshire. Although ticks are likely to be active any time the temperature is above freezing, you are more likely to contract a tick-borne illness in the spring or summer months.

“While there are several tick-borne illnesses to watch out for in our area, they are carried by the smaller Deer [or Black Legged] Ticks, not Dog Ticks,” says Marika Henegan, MD, a provider at Cheshire’s Urgent Primary Care Visits (Urgent Visits). “A baby, or nymph, Deer Tick can be hard to notice, which is why checking yourself thoroughly for ticks is important after you have been in the woods or long grass.”

Tick identification

At first glance, a nymph may just look like a small brown or black spot that is hard to remove. However, all ticks have 8 legs, even if you need a magnifying glass or your phone’s camera zoom function to see them. Most Lyme disease cases are caused by nymph ticks because larger ticks are more easily discovered and removed. Be sure to check warm regions such as under arms and groin carefully, as ticks prefer warm, damp conditions and nymphs can be difficult to see among hair.

As pictured below, Deer (Black Legged) Ticks are small with dark heads and legs and bodies that vary in color depending on their sex and how much they have fed. Dog Ticks are lighter brown and easier to see due to their size. The Centers for Disease Control (CDC) reports that Lone Star Ticks, pictured here, are generally only found in the Southeast U.S. and rarely north of Massachusetts.

The CDC notes that unengorged (unfed) Deer (Black Legged) Ticks are typically flat. If the tick has a swollen or rounded body, and the color has changed from brick red to a gray or brown, is an indication that the tick has been feeding and may have been attached for more than 36 hours.

CDC's image of the life stages of different ticks

What should I do if I find a tick on me?

“Don’t panic. If it is not attached, you have nothing to worry about. If you are sure the Deer [Black Legged] Tick has been attached for less than 36 hours, no further action is required (beyond removing the tick and cleaning the bite area) and this does not require a visit to a healthcare provider,” says Henegan.

“If you aren’t sure how long it has been attached or know that it has been more than 36 hours, seek medical attention that day or the next. Medication to help prevent Lyme disease can be given up to 72 hours after removing the tick.”

A course of antibiotics in the early stages of Lyme disease allows most people to recover rapidly and fully. Early treatment is important even if you don’t feel sick, to prevent late Lyme disease, which can be more difficult to treat. The antibiotic regimen and dose will vary according to your age and medical history but often lasts two or more weeks.

If you are pregnant: please see a doctor if there is any chance a Deer (Black Legged) Tick could have been attached for 36 hours or more.

How do I safely remove an attached tick?

Once a tick bites you, it will likely attach itself to you and won’t let go until it is full. Depending on the type of tick, this may take 3-10 days. The CDC recommendations are:

  • Do not try to remove an attached tick with your fingers. Squeezing its body rather than its head puts you at greater risk of contracting tick-borne illnesses.
  • Remove the tick immediately by grasping the head with fine-nosed tweezers as close to the skin as possible. Do not twist the tick. Instead, use a slow, steady, upward motion to pull the tick off. This minimizes the chances you will squeeze the body or leave the head behind.
  • Clean the bite area with alcohol or disinfecting soap and water, then treat with a topical antibiotic.
  • Get help from the CDC Tick Bite Bot 

“If you have removed the tick at home, place it in alcohol or a Ziploc baggie and bring it with you to your appointment,” Henegan says. “We are experienced at identifying ticks and this can help determine your recommended course of treatment. And remember you don’t need to make an appointment for a Primary Care Urgent Visit in at Cheshire. We’re here for you 365 days a year.”

Possible symptoms of tick-borne illness

The most common symptoms of tick-related illnesses are:

  • Fever/chills
  • Aches and pains in muscles or joints
  • Fatigue
  • Rash (appearance can vary by disease), typically a circular non-itchy or painful rash at the site of the bite, but it can be elsewhere. The rash usually appears 3-14 days after the infected tick bite.

Other symptoms to look for:

  • Severe headache
  • Swollen lymph nodes
  • Swollen joints
  • Problems with memory or concentration
  • Gastrointestinal distress (nausea, vomiting, diarrhea)

How can I prevent tick bites in the first place?

The CDC and NH Health and Human Services recommend:

  • Mow your lawn short, removing leaf litter and including a buffer of a few feet of wood chips around the edge. Most Deer Ticks found in yards are within 9 ft of the edge of woodland or brush.
  • Tuck in your shirt, tie your hair back and tuck your pants into your socks while in underbrush or woods. Although ticks can be more easily spotted on light clothing, a recent study showed they are more attracted to light clothing than dark.
  • Use your insect repellent of choice as directed on the instructions and treat clothing (not skin) carefully with permethrin, an insecticide which is effective through a few washes.
  • Shower thoroughly within 2 hours of coming inside.
  • Put clothes in the dryer for 10 minutes (or more than 20 if wet) after coming inside.
  • Perform thorough tick checks daily, even when you haven’t been outside in 24 hours, as ticks can hide in clothing or hitch a ride on pets. They often crawl to areas like armpits, behind your ears, in your hair, or between your toes, so perform checks carefully in front of a mirror after a shower.

You do not need an appointment to visit Cheshire’s Urgent Visits. Open 365 days a year at Cheshire Medical Center, the clinic’s hours are Monday through Friday, 8 am to 8 pm, Saturday and Sunday, 10 am to 4 pm, and 10 am to 2 pm on holidays. Visit our site for more information.

For more information

Centers for Disease Control Tick Resources

Ticks Attracted to Light vs. Dark Clothing

American Lyme Disease Foundation

International Lyme & Associated Diseases Society