Lyme disease: symptoms, tick bites, treatment and recovery

The NHS says a circular or oval rash around a tick bite can be an early symptom in some people. It can appear up to 3 months after the bite but usually within 1 to 4 weeks, and can last several weeks. It may have a darker or lighter area in the centre, may gradually spread, and is not usually hot or itchy. It may look like a bullseye on a dartboard, and can be harder to see on brown and black skin, where it may look like a bruise.

NHS inform says the rash usually develops 3 to 30 days after a bite, is usually around 15 cm across but can be smaller or much larger, and some people have several rashes. It says around 1 in 3 people with Lyme disease will not develop a rash.

The NHS says ticks are tiny spider-like creatures that live in woods, areas with long grass, and sometimes in urban parks and gardens. They do not jump or fly but attach to the skin of animals or people that brush past them, then feed on blood for a few days before dropping off. Not all ticks in England carry the bacteria. Tick bites are not always painful, so you may not notice one.

NHS inform says you are more likely to become infected the longer the tick is attached, so removing it quickly is important. The NHS gives the following steps. The chance of getting ill is low, and you do not need to do anything else unless you notice a rash or become unwell.

• use fine-tipped tweezers or a tick-removal tool

• grasp the tick as close to the skin as possible

• slowly pull upwards, taking care not to squeeze or crush the tick

• dispose of it once removed

• clean the bite with antiseptic or soap and water

The NHS says that if a GP thinks you might have Lyme disease, they will prescribe a course of antibiotics, and treatment is more effective if started as soon as possible. Depending on your symptoms you may need to take them for up to 28 days, and it is important to finish the course even if you feel better. Severe symptoms may need referral to hospital for antibiotics given directly into a vein.

NICE Clinical Knowledge Summaries lists antibiotic courses for adults and children aged 12 or over such as doxycycline for 21 days, amoxicillin for 21 days or azithromycin for 17 days, with other regimens for younger children. NHS inform notes that some of the antibiotics can make skin more sensitive to sunlight, so avoid prolonged sun exposure and sunbeds until you have finished treatment.

The NHS says Lyme disease can be difficult to diagnose because it has similar symptoms to other conditions and there is not always an obvious rash. A GP will ask about your symptoms and consider any rash or recent tick bites. Two types of blood test are available to help confirm or rule out Lyme disease, but they are not always accurate in the early stages, so you may need to be retested if you still have symptoms after a negative result.

NICE says people should be treated without waiting for tests if they have the characteristic rash. NICE Clinical Knowledge Summaries describes the erythema migrans rash as occurring only in Lyme disease, and recommends an ELISA blood test if Lyme disease is suspected without the rash.

NHS inform explains that some animals carry the bacteria that cause Lyme disease. If a tick bites the animal, it becomes infected and can transfer the bacteria to a human by biting them. Lyme disease is also called Lyme borreliosis. NICE Clinical Knowledge Summaries names the bacteria as Borrelia burgdorferi.

The sources read for this guide describe infection through tick bites. Ticks that may cause Lyme disease are found all over the UK, and the NHS lists grassy and wooded areas in southern England and the Scottish Highlands as higher-risk. NHS inform says risk is higher for people who spend time in woodland or moorland from March to October.

The NHS says to ask for an urgent GP appointment or get help from NHS 111 if you have been bitten by a tick or visited an area in the past 3 months where infected ticks could be, and you either feel unwell with flu-like symptoms, or have a round or oval rash. Tell them if you have recently been in forests or grassy areas.

NHS inform says there is currently no vaccine to prevent Lyme disease, but you can reduce tick bites.

• stay on clear paths and avoid long grass when walking outdoors

• cover your skin, wear long sleeves and trousers tucked into your socks

• wear light-coloured clothing so ticks are easier to see and brush off

• use insect repellent on clothes and skin; the NHS says products containing DEET are best

• check skin and clothing for ticks after being outdoors, including children's heads and necks, and check pets

The NHS says that most people with Lyme disease get better after antibiotic treatment, although this can take months for some people. A few people who are diagnosed and treated continue to have symptoms such as tiredness, aches and loss of energy that can last for years. These are often compared to fibromyalgia and chronic fatigue syndrome. It is not clear why this happens, and there is no agreed treatment.

The NHS says to speak to a doctor if symptoms come back or do not improve after antibiotics, as further support may be offered, such as a care needs assessment or a gradual return to activities. It also warns that some websites offer tests and treatment that may not be supported by scientific evidence, so speak to a doctor before buying them.

NHS inform advises checking children's skin for ticks, especially the head and neck areas including the scalp, after being outdoors. NICE Clinical Knowledge Summaries lists different antibiotic regimens for children by age and weight, so children should be assessed by a doctor.

The sources read for this guide do not give pregnancy-specific advice. If you are pregnant and have been bitten by a tick or have a spreading rash, ask for an urgent GP appointment or call NHS 111, because antibiotic choice may differ.

On the NHS, Lyme disease is diagnosed and treated by a GP, with hospital referral for severe or persistent symptoms. The NHS and NHS inform both caution against internet sites offering alternative tests and treatments, so if you pay for private testing, ask whether the tests used follow the same recommended two-step blood testing and discuss results with a doctor.