From the Research
For a tick that was attached for 12 hours, testing for Lyme disease should be considered if symptoms develop, as testing immediately after tick removal is not recommended. Watch for symptoms like fever, rash (especially the characteristic bull's-eye rash called erythema migrans), fatigue, headache, muscle/joint pain, or swollen lymph nodes for up to 30 days after removal. If symptoms appear, seek medical attention for a two-tier testing approach: first an enzyme immunoassay (EIA) or immunofluorescence assay (IFA), followed by a Western blot test if the first test is positive. Testing too early can lead to false negatives since antibodies take time to develop.
Key Considerations
- Prophylactic treatment with a single 200mg dose of doxycycline may be considered if the tick was attached for more than 36 hours and was identified as an Ixodes tick (deer tick), but this isn't typically needed for ticks attached less than 24 hours since transmission risk is lower during the first 24 hours of attachment 1, 2.
- A study published in 2021 found that a single dose of doxycycline after a tick bite can prevent the development of Lyme borreliosis in Europe, with a relative risk reduction of 67% 1.
- Another study published in 2021 found that antibiotic prophylaxis can prevent Lyme disease, with a pooled risk ratio of 0.38 (95%CI: 0.22-0.66) 2.
- The most recent study in 2024 found that single-dose doxycycline dispensings in an outpatient cohort in the United States were mostly in patients aged ≥65 years, and that Lyme disease postexposure prophylaxis may be underprescribed for some groups, including children 3.
Recommendations
- Monitor for symptoms of Lyme disease for up to 30 days after tick removal.
- Seek medical attention if symptoms appear for a two-tier testing approach.
- Consider prophylactic treatment with a single 200mg dose of doxycycline if the tick was attached for more than 36 hours and was identified as an Ixodes tick (deer tick).