Lyme Disease and Ticks: A Guide for UK Travellers and Hikers

Lyme disease, or Lyme borreliosis, is an infection caused by the bacterium Borrelia burgdorferi. In the UK, these bacteria are carried by certain species of hard-bodied ticks, most notably the sheep tick (Ixodes ricinus). Ticks do not fly or jump; instead, they wait on the tips of long grass or foliage and latch onto passing humans or animals in a process called questing.

While many tick bites are harmless, an infected tick can transmit the bacteria into the bloodstream while feeding. The NHS estimates that there are approximately 3,000 to 4,000 new cases of Lyme disease in England and Wales each year. Understanding the risks and knowing how to respond to a bite is essential for anyone enjoying the UK countryside or travelling to high-risk areas in Europe and North America.

The most distinctive symptom of Lyme disease is a skin rash called erythema migrans. This rash typically appears 3 to 30 days after a bite and has several unique characteristics:

• Appearance: It often looks like a bullseye on a target, with a central red spot surrounded by a clear area and an outer red ring.
• Texture: The rash is usually flat and not typically itchy or painful.
• Growth: It slowly expands over several days, sometimes reaching up to 30cm (12 inches) in width.
• Location: While it usually appears at the site of the bite, it can occur elsewhere on the body.

It is important to note that according to NICE guidelines, around 30% of people with Lyme disease do not develop a rash. Other early symptoms can feel similar to a heavy flu, including high temperature, headache, muscle and joint pain, and fatigue.

If you find a tick attached to your skin, you should remove it as soon as possible. The risk of Lyme disease increases the longer the tick remains attached, but it is generally low if the tick is removed within 24 hours. Follow these steps for safe removal:

• Use a tick-removal tool (available from most UK pharmacies) or fine-tipped tweezers.
• Grasp the tick as close to the skin as possible, specifically at its head/mouthparts.
• Pull upwards slowly and firmly without twisting or squeezing the tick's body, as this can force infected fluids into your skin.
• Once removed, clean the bite area with antiseptic or soap and water.
• Dispose of the tick by flushing it down the toilet or placing it in a sealed bag in the bin.

Avoid using traditional 'remedies' such as burning the tick with a match or covering it in petroleum jelly, as these methods are ineffective and can increase the risk of infection.

If you have been bitten by a tick and are worried, or if you have recently visited a wooded or grassy area and feel unwell, seeking medical advice is a sensible step. You should consult a GP or speak to an online doctor if:

• You notice a circular, expanding rash (the bullseye rash).
• You develop flu-like symptoms such as fever, chills, or fatigue following a known tick bite.
• The area where you were bitten looks red, swollen, or produces pus (this may be a sign of a localized skin infection).

An online doctor can review photos of your rash and discuss your symptoms. They can provide advice based on the NICE clinical guidelines for Lyme disease and, if appropriate, prescribe the necessary course of antibiotics to clear the infection before it progresses to more serious stages.

Lyme disease is highly treatable with a course of antibiotics. The type and duration of the treatment depend on the stage of the infection and the patient's age. For early-stage Lyme disease (the rash or flu-like symptoms), a 21-day course of doxycycline is the standard first-line treatment for adults in the UK. If doxycycline is not suitable (for example, in pregnant women), amoxicillin or azithromycin may be used.

If the infection is caught early, most people make a full and rapid recovery. However, if left untreated, the bacteria can spread to the nervous system, heart, or joints, leading to more complex symptoms like facial drooping (Bell's palsy), nerve pain, or inflammatory arthritis. In these late-stage cases, intravenous antibiotics administered in a hospital setting may be required.

Prevention is the best defence against Lyme disease. When walking in high-risk areas—such as the New Forest, the South Downs, or the moors of Yorkshire—consider the following precautions:

• Cover up: Wear long-sleeved shirts and tuck your trousers into your socks.
• Light colours: Wear light-coloured clothing to make it easier to spot small, dark ticks crawling on you.
• Repellent: Use an insect repellent containing DEET on your skin and clothing.
• Stay on paths: Avoid walking through tall grass or dense undergrowth where ticks are most active.
• Tick checks: Perform a thorough body check on yourself, your children, and your pets after being outdoors. Ticks love warm, moist areas like the armpits, groin, and behind the knees.