Tick Bite Symptoms You Shouldn’t Ignore (And Some That Never Show)

Tick bite symptoms don’t always show up to warn you that you’ve got Lyme disease, but you do need to pay attention to them.

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Tick bite symptoms are about as maddening as it can get. Sometimes they show up. Sometimes they decide to hide like an ostrich with its head in the sand. And yet, everywhere you turn, there are warnings that getting bitten by a pesky tick can put you at risk for some serious diseases, including Lyme, the most rampant tick-borne disease of them all. If you’ve been bitten by a tick or you’re wondering if one of those wily arachnids snacked on your skin, you’re probably searching for a rash that looks like a bullseye somewhere on your body. So what happens if you find one? And, for that matter, what happens if you don’t?

Tick Bite Symptoms: The Bullseye

The bullseye rash has become synonymous with tick bite symptoms ever since Yale University researchers first discovered Lyme disease and deer ticks—the critters spreading the infection—way back in the 1970s. The first cases of Lyme disease cropped up in and around Lyme, Connecticut (hence the name), where 51 residents were diagnosed with juvenile arthritis or arthritis of unknown cause. The more research scientists did, the more sure they were that the problem was the bite of the deer tick, or Ixodes scapularis. Fast forward some 40 years, and the Centers for Disease Control (CDC) estimates 329,000 cases of Lyme disease now occur annually in the United States. The species of tick that makes people sick has spread from Connecticut to 14 states in the Northeast and upper Midwest, and they typically come out to bite people during the late spring, summer, and early fall (from about April to October). As the tiny disease-carrying creatures have spread, the tick bite symptoms that doctors tell patients to look for have changed rather drastically too.   The bullseye that was once known as a classic sign that someone has been bitten by a tick and was at high risk of contracting Lyme is no longer a given, says Bruce Robinson, MD, a clinical professor of dermatology at Lenox Hill Hospital in New York City and the creator of JAS, Just Amazing Skincare, a plant-based skincare collection. “It can look like an ordinary mosquito bite,” Robinson says of a tick bite. “It can look like any version of a bite from a filled-in circle of red to a bullseye.” In fact, Robinson finds that many patients show up thinking they have a “new mole,” only to find out that the new spot on the body is actually a tick bite. Even more confounding? Different bodies react differently to tick bites, says David Claborn, doctor of public health and director of the master of public health program at Missouri State University. Your tick bite symptoms might include itching. Your friend’s tick bite symptoms might involve pain. But each of you could have been bitten by the same little critter! “Much depends on the body’s reaction to the bite,” Claborn explains. “Allergic reactions can cause a great deal of discomfort—or worse. If the person has pulled the tick off, the tick’s mouthparts may have been left in the bite site and these can fester up.”

Why Tick Bites Are So Dangerous

Being bitten by a tick is unpleasant. It can itch. It can cause pain, and for some people, diseases and other conditions can set in. For example, Claborn says, if the tick is feeding near the spinal cord or base of the brain, a type of paralysis called tick paralysis can occur. This usually resolves quickly after the tick is removed or drops off. Another condition linked to tick bites causes an allergy to red meat, Claborn says, although the full explanation for how this allergy develops is not yet known. There’s also ehrlichiosis (a bacterial disease fairly common in parts of the U.S.), Rocky Mountain spotted fever, tularemia (a bacterial disease often associated with hunting rabbits that is actually transmitted by ticks) and diseases common to the Midwest caused by the Bourbon virus and the Heartland virus.

For some people, Lyme disease can go away on its own within several weeks, but for others, if not treated, Lyme disease can spread to the central nervous system, muscle and joints, eyes and heart.” —Jack Cornwell, MD

Finally, there’s  Lyme disease, the most common tick-borne illness in the U.S. Every year, approximately 30,000 cases of Lyme disease are reported to the CDC by state health departments and the District of Columbia, but the CDC estimates there are substantially more cases that go undiagnosed and thus unreported. It’s Lyme disease that gets the most attention in part because it’s most prevalent but also because it has devastating effects for some people who don’t get treatment or aren’t treated in a timely manner. “For some people, Lyme disease can go away on its own within several weeks,” explains Jack Cornwell, MD, medical director at CareWell Urgent Care, “but for others, if not treated, Lyme disease can spread to the central nervous system, muscle and joints, eyes and heart.” “Everyone’s body reacts differently, and symptoms may vary in severity,” Cornwell continues, “but since Lyme disease can affect multiple systems, it’s important to see a doctor right away if you suspect it.”

When will tick bite symptoms show up?

What tick bite symptoms should you be looking for, and when should you be looking? Unlike a bee that stings and flies off quickly or even a mosquito that lands, snacks, and flies away within seconds, ticks stick around on your body. An adult female tick can actually stay for as long as 7 to 10 days without being noticed, although nymphs (young ticks) or larvae (very young ticks) tend to feed off a subject for less than four days according to Robinson.

Tick Bite Symptoms You Shouldn’t Ignore (And Some That Never Show)
Some more good news here: In most cases, to transmit Lyme disease, a deer tick has to be attached to its host for 36 to 48 hours, Robinson says. Grabbing a tweezer and pulling that sucker off before it hits that point means you can usually stop potential infection before it sets in, although it’s still good to check in with your doctor as your estimate of how long the tick was attached may be off. Gross? Yes. But if you don’t notice a tick using you as a snack, don’t beat yourself up too hard. It happens, and it’s extremely common—hence the CDC’s warning that estimates of Lyme disease are on the low side. Ticks are tiny, even smaller than your pencil eraser, so you may or may not notice one on your body. And they like to move into warm, moist spots on the body, such as the crack of your butt or the fold between your leg and labia (or penis). And even when they drop off, the signs that a tick has bitten you may not be immediate. Rashes may appear anywhere from 3 to 40 days after a bite, Robinson warns. Even then, the rash only occurs in about 70 to 80 percent of the population. When it does, it will typically (but not always!) look like a bullseye or target that expands gradually over a period of days, spanning a diameter of 12 inches (30 cm) or more across. You may also experience fever, chills, headache, fatigue, muscle and joint aches, and swollen lymph nodes. Any or all of these symptoms of a tick bite are reason to head to your doctor ASAP. If Lyme isn’t caught early, it can progress to additional symptoms, including:

  • Severe headaches and neck stiffness
  • Additional rashes on other areas of the body
  • Arthritis with severe joint pain and swelling, particularly the knees and other large joints.
  • Facial palsy (loss of muscle tone or droop on one or both sides of the face)
  • Intermittent pain in tendons, muscles, joints, and bones
  • Heart palpitations or an irregular heartbeat (known as Lyme carditis)
  • Episodes of dizziness or shortness of breath
  • Inflammation of the brain and spinal cord
  • Nerve pain
  • Shooting pains, numbness, or tingling in the hands or feet
  • Problems with short-term memory

Tick Bite Testing

Once you show up in the doctor’s office, they’ll examine your rash or bite mark—if you have one—and run some blood tests. Unfortunately, even if you are tested for Lyme, as many as 60 percent of cases are missed by diagnostic testing, says Jo Ellis, director of education with Bay Area Lyme Foundation. And that’s even when doctors use the blood tests that are what Ellis calls the “gold standard” for diagnosing Lyme. “As a result of the difficulty in diagnosing and treating Lyme disease, at least 500,000 Americans, and possibly up to one million, suffer from its debilitating later-stage symptoms,” Ellis says. So what does that mean for you if you’ve been bitten by a tick? If you continue to experience any of the symptoms mentioned above, follow up with your doctor immediately. Sometimes performing the test at a later date may result in a positive. Some doctors have now taken to treating patients prophylactically—aka without a confirmed diagnosis—if it can be confirmed that they were bitten by a tick (an attached tick or a bullseye rash are major indicators). But that means calling your doctor very quickly after a suspected tick bite, Cornwell notes.

Many doctors’ offices and urgent care centers have the ability to send ticks out for testing for Lyme, which can help a doctor make the diagnosis even if a blood test is negative.

“The window for taking prophylactic doxycycline, the medicine that decreases the likelihood that you develop Lyme disease, closes between 48 and 72 hours after infection,” he warns. If you found the tick attached to your body and you were able to remove it with a pair of tweezers, you can stick it in a Ziploc baggie and bring it along to your doctor’s office for testing, although it’s not required. “There is no way to know for sure if a tick is carrying Lyme disease or not unless the tick is tested,” Cornwell explains. Many doctors’ offices and urgent care centers have the ability to send ticks out for testing for Lyme, which can help a doctor make the diagnosis even if a blood test is negative. This only works if the entire tick is intact, however, so Cornwell is quick to warn patients to pull gently with their tweezers so they can ensure they get the entire tick off the skin. If the tick comes out in pieces, however, don’t stress yourself, especially if you’re not showing any symptoms! “Plenty of laboratories offer to test ticks to determine whether they’re carrying any diseases. But that’s generally not worth your money,” Robinson notes, explaining that the tests can be $50 or more at some labs. “Even if the tick is infected with something, it doesn’t mean that it was able to transmit that infection, and if your tick comes back positive for Lyme disease or another infection, you probably won’t be treated unless you yourself start having symptoms.”

Don’t anger the tick!

Notice that the experts suggest grabbing a set of tweezers to remove a tick? No matter what you’ve seen on Pinterest or what your best friend swears her grandpa used to do to remove a tick, tweezers are the only doctor-recommended removal method for ticks. “Common folk wisdom strategies for getting that tick to detach include holding a lit match toward it, smothering it with petroleum jelly or nail polish, and dabbing the spot with acetone or bleach,” Robinson says, but he’s quick to note that “all are questionable ideas!” “With the lit-match strategy, you may just end up burning yourself, and while you might kill the tick, that won’t necessarily cause the tick to detach,” he warns. “ A dead tick is not going to come off any more easily than a live tick. As for the other methods above, even if they do work—and it’s not clear that they will—they may take long enough to allow a tick to pass on an infection.” So grab the tweezers and grasp the tick as close to the surface of your skin as possible (this way you get the head as well as the body). Then firmly but steadily pull the tick directly backward from the bite site without twisting or jerking, Robinson suggests. If there are still bits of the tick in the bite, use the tweezers to remove them as well. After everything’s gone, grab the rubbing alcohol and a cotton swab or a washcloth with soap and water, and clean the area to prevent additional infection of the wound.  

Don’t panic.

Although the number of Lyme cases in the U.S. has been trending upward and tick bites are not to be ignored, simply being bitten by a tick does not mean you will get sick. “Only 2 percent of tick bites result in Lyme disease,” Cornwell says, “So while it’s important to be proactive, not every bite will result in an infection.”

Jeanne Sager
Jeanne Sager is a writer and photographer from upstate New York. She has strung words together for The New York Times, The Washington Post, The Atlantic, and more.