What to Do if Bitten

Carefully Remove the Tick

Remove an attached tick as soon as safely possible. For some infections, the longer a tick remains attached, the higher the risk of transmission. However, transmission times vary, and not all tick bites lead to infection.

To safely remove a tick:

Use fine-tipped tweezers to grasp the tick as close to the skin as possible. Pull the tick straight up and out, slowly and carefully.

Do not twist the tick or pull the tick out at an angle. Do not use your fingers to pinch or pull the tick out.

After removing the tick, wash your hands and the bite area with soap and water.

Save the Tick

If a tick was attached to your skin, don’t throw it away. Save it. Place it in a sealed zip-top bag or small container. Record the date it was removed, where you may have encountered it, where it was attached to your body, and approximatelly how long it may have been attached.

Saving the tick can allow it to be identified. Knowing the tick species can help you and your healthcare provider understand which tick-associated conditions may be relevant and what symptoms to watch for.

Identify the Tick

Correctly identifying a tick is an important first step after a bite. Knowing the type of tick can help determine which diseases may be associated with that exposure and what signs and symptoms to monitor in the days and weeks that follow.

TickSafety.com provides detailed information on how to identify a tick, including images of when they are engorged. You can also submit a picture or text a picture to 703-828-4343 for free identification.

You can also use this tick identification chart from the Virginia Department of Health to determine both the type and life stage of a tick. Certain life stages, particularly nymphs, are more likely to transmit disease, mainly due to their tiny size and the increased chance of missing them. Keep in mind that nymphs and larvae are very small and can be difficult to distinguish without magnification.

If you find a tick in Virginia, consider reporting it to the VDH Virginia Tick Survey—particularly if the tick was not attached. If a tick is attached to your body, it is recommended to safely remove it and keep it (for example, in a sealed bag or container) in case identification or testing is needed later.

Since 2018, the Lone Star tick has been the species most commonly reported through the VDH Virginia Tick Survey. Its bites are associated with alpha-gal syndrome and STARI, and it can transmit pathogens that cause ehrlichiosis, tularemia, and Heartland virus disease.

Monitor for Symptoms

After a tick bite, it’s important to monitor your health over the next few days to weeks. Not everyone bitten by a tick will become ill, but early recognition of symptoms can significantly impact treatment and recovery.

Some symptoms may appear within a few days, while others can take weeks or longer to develop. For example, a rash associated with Lyme disease may appear within several days after a bite, while symptoms of alpha-gal syndrome may not become apparent until weeks or months after a tick bite, and may occur several hours after consuming certain mammalian products.

Be on the lookout for new or unusual signs, including:

Fever or chills
Fatigue or unusual tiredness
Headache
Muscle or joint aches
Swollen lymph nodes
A new or spreading rash
Facial weakness or drooping
Unexplained digestive symptoms
Allergic symptoms after consuming mammalian meat or other mammalian-derived products

Seek emergency medical care for difficulty breathing, swelling of the lips, tongue, or throat, fainting, or other signs of a severe allergic reaction.

If you experience symptoms, especially after a known or possible tick bite, contact your healthcare provider and share details about your exposure.

Early evaluation can help prevent more serious illness.

Talk With Your Provider About Testing

If you develop symptoms after a known or possible tick bite, contact a healthcare provider to discuss appropriate testing. Share the date and location of the exposure, the type of tick if known, how long it may have been attached, whether it appeared engorged, and when your symptoms began.

Testing after a tick bite depends on your symptoms, exposure, and when they began. Ask your healthcare provider whether evaluation or testing for Lyme disease and other illnesses found in Virginia, such as anaplasmosis, ehrlichiosis, spotted fever rickettsioses, babesiosis, and tularemia, may be appropriate. If you develop delayed allergic reactions after eating mammalian meat or other mammalian-derived products, ask about testing for alpha-gal syndrome.

Alpha-gal syndrome is diagnosed based on clinical symptoms and a blood test for alpha-gal–specific IgE antibodies. A positive result indicates sensitization but does not, by itself, mean that someone has alpha-gal syndrome. Learn more on our Alpha-gal in Virginia page.

Lyme disease blood testing generally uses FDA-cleared serologic tests to detect antibodies. Testing methods continue to evolve, and different illnesses require different tests at different times. Discuss which tests are appropriate and how the results should be interpreted with your healthcare provider.

Tick-borne disease testing in humans is not perfect. False-negative and false-positive results can occur, particularly in the early stages of illness. In Virginia, under Virginia Code §32.1-137.06, laboratories reporting certain Lyme disease test results must include a notice explaining that testing may produce false-negative and false-positive results and advising patients to continue consulting their healthcare provider if symptoms persist.

If initial results are negative but symptoms persist or worsen, follow up with your healthcare provider. Depending on the timing, symptoms, and suspected condition, repeat testing, a different type of test, or referral to a specialist may be appropriate.

Some patients seek a provider described as Lyme-literate Medical Doctor (LLMD), particularly when symptoms persist or a diagnosis remains uncertain. This generally refers to a clinician with advanced training or experience in Lyme disease and other tick-borne illnesses; however, it is not a standardized medical credential, and approaches to testing and treatment may vary. Most importantly, look for a licensed provider who listens to your concerns, considers your symptoms and exposure history, and clearly explains the benefits and limitations of recommended testing and treatment.

Additional testing through specialty laboratories may also be considered. These laboratories may offer different tests or evaluate additional pathogens, but their methods, costs, interpretation criteria, and supporting evidence vary. Examples include IGeneX, Vibrant Wellness, DNA Connections, and Armin Labs. Decisions about additional testing should be made in consultation with a knowledgeable healthcare provider. Ticks in Virginia provides these resources for informational purposes and does not endorse a specific laboratory.

Important to Remember

A positive antibody test indicates an immune response but may not, by itself, establish an active illness.
A negative test does not fully rule out disease, especially early after a bite.
Results should always be interpreted alongside symptoms and exposure history.

Tick Bite Consultations

RavelHealth has a new, telehealth service that offers 15-minute tick bite consultations. During the consultation, you can speak with a licensed healthcare provider who specializes in tick-borne diseases, ask questions, discuss medications, and get prescriptions sent to the pharmacy of your choice.

Available in all 50 states, D.C. & Puerto Rico. Learn more at RavelHealth

Consider Tick Testing

Not all ticks carry disease-causing pathogens, but some ticks can carry more than one. Testing a saved tick may provide additional information about pathogens detected in that particular tick. Results can be considered alongside the tick species, attachment and engorgement, symptoms, exposure history, and human testing as one potential piece of the larger puzzle.

However, it is important to understand:

A positive result means a pathogen was detected in the tick; it does not mean the pathogen was transmitted to you.
A negative result applies only to the pathogens included in the testing panel and does not completely rule out exposure or illness.
Tick testing cannot determine whether someone will develop alpha-gal syndrome because AGS is an allergic condition, not an infection.
Results should not delay medical evaluation or be used alone to make diagnosis or treatment decisions.

While not all providers or public health agencies routinely recommend tick testing, having information about the tick may help guide conversations about care and next steps and provide peace of mind, as many ticks do not carry disease. Perspectives on tick testing may vary, but results may support more informed discussions with your provider.

Tick testing services:

TickCheck – www.tickcheck.com | (866) 713-TICK
TickReport – www.tickreport.com | (413) 545-1057
Ticknology – www.ticknology.org | (970) 305-5587

Learn More

Visit our For Patients page for information on what to do after your diagnosis.

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