With summer here, people are spending more time enjoying nature, but the warmer months also bring a reminder from experts to protect yourself against ticks when out hiking, camping, or playing outside. And people aren’t the only ones susceptible to tick bites – so are pets, who can bring them inside.

Dr. James "Sloan" Manning smiles in a white lab coat.
Dr. James "Sloan" Manning

While ticks are more active in summer months, tick season never really ends in North Carolina since the weather is so temperate, said Dr. James "Sloan" Manning, a family physician at Novant Health Salem Family Medicine. It’s important to stay vigilant, Manning said, since tick bites can expose people and pets to several tick-borne diseases including Lyme disease, Rocky Mountain spotted fever (RMSF), Powassan virus and several other diseases.

What to know about Lyme disease

Each year, about 30,000 cases of Lyme disease are reported to the Centers for Disease Control and Prevention (CDC). The CDC is careful to point out that doesn’t capture the whole picture. Experts said other estimates indicate it’s closer to half a million U.S. people who get Lyme disease annually. If left untreated, infection can spread to joints, the heart, and the nervous system.

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The typical rash of Lyme disease is known as erythema migrans (EM for short, meaning advancing redness), a red to blue-violet ring that enlarges as the Lyme bacterial advance away from the tick bite. It can, at times, take on the appearance of a “bulls-eye.” EM is evidence of early Lyme infection and can be treated with several common antibiotics.

Be mindful of Rocky Mountain spotted fever

North Carolina has one of the highest incidences of RSMF in the country, said Manning. The disease is caused by a bacteria, carried most often in the southern and eastern U.S. by the American dog tick. Despite its name, the tick is indiscriminate and will feed on people, as well as dogs.

“Any flu-like illness from spring to late fall should arouse concern for RMSF. Of course, we must consider COVID-19, too, during the ongoing pandemic,” Manning said.

It takes two to 14 days to develop symptoms after being bitten by an infected tick, he added. People who acquire RMSF will experience flu-like symptoms such as fever, chills, headache, rash, nausea, vomiting and often, abdominal pain. When someone presents with these symptoms, Manning will conduct an evaluation, and asks if they have been in a wooded environment or places with high grass.

“About one in 10 persons will not develop the rash. Some will not remember a tick bite, as nymph or ‘seed’ ticks that attach for a brief period and then fall off may also carry the disease,” Manning said. “As providers, we examine the forearms and wrists to look for a rash of red to purplish little dots that blanch with pressure for the first few days of the illness. The bacteria of RMSF causes an inflammatory reaction in the blood vessels and can affect any body organ.”

People can be treated on suspicion of having RMSF, pending blood work for antibody levels as confirmation. The antibiotic doxycycline is the first line of treatment for RMSF and the CDC recommends a patient start a course of treatment immediately. However, Manning said it’s equally as important not to treat unless there are symptoms of the illness.

Don’t panic: a tick bite doesn’t always result in illness

Manning cautioned that people get bitten by ticks all the time, but in most cases, they will not develop Lyme disease or RMSF.

“Most ticks do not carry these illnesses,” he said. “In most cases, removing the tick using tweezers with firm pressure will do, but if you need reassurance contact your provider to discuss any symptoms you might have. Under certain conditions, a single dose of doxycycline can be used to prevent Lyme disease, but it is important to check with a health care provider to be certain you meet the conditions for single dose prevention.”

Take these precautions to avoid tick bites:

  • Apply insect repellent containing DEET to exposed skin and clothing.
  • Wear clothing and gear, such as boots, long pants, long sleeve shirts and socks, treated with 0.5 percent permethrin.
  • Bathe or shower as soon as possible after coming indoors to wash off and more easily find ticks.
  • Conduct a full-body tick check using a hand-held or full-length mirror to view all parts of your body, including under the arms, in and around the ears, inside the belly button, behind the knees, between the legs, around the waist and especially in the hair.
  • Make sure your pets are treated monthly with flea and tick protection.

“It takes several hours to a day or so for a tick to transmit bacteria into the skin,” he added. “If you’ve developed a fever, rash or other typical symptoms of Lyme or RMSF, you should seek medical attention.”

Manning urged people who are active in the outdoors to visit the CDC’s website on tick-borne diseases in order to better inform themselves about the prevention and symptoms associated with tick illness.