Lyme Disease Prevention: A UK Guide for Hikers and Travellers

Lyme disease, or Lyme borreliosis, is a bacterial infection transmitted to humans through the bite of infected black-legged ticks. In the UK, these ticks are common in grassy and wooded areas, particularly in the Scottish Highlands, southern England, and the Lake District. However, they can be found in urban parks and gardens as well.

While not every tick carries the Borrelia burgdorferi bacteria, the number of cases in the UK has been steadily rising. According to NHS guidance, there are approximately 3,000 to 4,000 laboratory-confirmed cases in England and Wales each year. Because the ticks are very small—sometimes no larger than a poppy seed—many people do not realise they have been bitten until symptoms appear.

One of the most distinctive symptoms of Lyme disease is a characteristic skin rash known as erythema migrans. This rash typically appears within 3 to 30 days of being bitten. It usually starts as a small red area but expands over several days to reach a diameter of up to 30cm.

• Appearance: It often looks like a bullseye on a dartboard, with a central red spot surrounded by a clear area and then a larger red ring.
• Texture: The rash is usually flat and is not typically itchy or painful.
• Location: While it often appears at the site of the bite, it can appear elsewhere on the body.

It is important to note that around 30% of people infected with Lyme disease do not develop a rash. In these cases, the infection may present as flu-like symptoms, including a high temperature, headache, muscle and joint pain, and fatigue.

Prevention is the best defence against Lyme disease. If you are planning to spend time outdoors, especially in areas with long grass or bracken, follow these evidence-based steps:

1. Dress Appropriately

Wear long-sleeved shirts and tuck your trousers into your socks. This creates a physical barrier that makes it harder for ticks to reach your skin. Light-coloured clothing is preferable as it makes it easier to spot dark ticks crawling on you.

2. Use Repellents

Apply an insect repellent containing DEET, Icaridin (Picaridin), or Lemon Eucalyptus oil to exposed skin and clothing. Permethrin-treated clothing is also an effective option for frequent hikers.

3. Stick to Paths

Ticks 'quest' by sitting on the ends of grass and reaching out for passing hosts. By staying in the centre of cleared paths, you reduce the chance of brushing against vegetation where ticks may be waiting.

4. Perform Tick Checks

After your walk, thoroughly check your body, your children, and your pets. Pay close attention to warm, moist areas such as the armpits, groin, back of the knees, and the hairline. Showering shortly after being outdoors can also help wash off unattached ticks.

If you find a tick attached to your skin, it should be removed as soon as possible. The risk of transmission increases the longer the tick remains attached (usually after 24–48 hours). Follow the NICE clinical knowledge summaries for safe removal:

• Use the right tool: Use fine-tipped tweezers or a specialised tick-removal tool (available at pharmacies).
• Grasp the head: Grasp the tick as close to the skin as possible.
• Pull steadily: Pull upwards with even, steady pressure. Do not jerk or twist the tick, as this can cause the mouthparts to break off in the skin.
• Clean the area: After removal, clean the bite site and your hands with antiseptic or soap and water.

Never try to burn the tick off, use petroleum jelly, or use nail varnish. These methods may cause the tick to regurgitate its stomach contents into your bloodstream, increasing the risk of infection.

If you have been bitten by a tick and feel perfectly well, you do not usually need to see a doctor. However, you should speak to a GP online or in person if:

• You develop the 'bullseye' rash (erythema migrans).
• You develop flu-like symptoms (fever, aches, tiredness) within a few weeks of a tick bite.
• You were bitten by a tick and are pregnant, as the infection can potentially affect the baby.
• The bite site looks red, swollen, and hot (which may indicate a secondary bacterial skin infection).

A GP can often diagnose Lyme disease based on the appearance of the rash alone. If you do not have a rash but have other symptoms, they may arrange a blood test to look for antibodies. When you consult an online doctor UK service, it is helpful to provide a clear photograph of any rash and details of where you have travelled recently.

Lyme disease is treated with a course of antibiotics, usually lasting two to three weeks. The specific antibiotic (often doxycycline or amoxicillin) depends on the patient's age and medical history, following NICE guidelines. It is vital to finish the full course, even if you start to feel better sooner.

Most people recover fully after antibiotic treatment. Some individuals may experience lingering symptoms such as fatigue or joint pain for several months, sometimes referred to as 'post-treatment Lyme disease syndrome'. While the cause of this is not fully understood, it is generally managed with supportive care rather than prolonged antibiotic use.