Tick bites: A dilemma in general practice

Tick bites are common, and an estimated 1 in 15 individuals bitten by a tick consult their general practitioner. In 2009, there were 93,000 consultations for tick bites in the Netherlands, a threefold increase compared with 1994. About 10% of ticks in the Netherlands are infected with Borrelia burgdorferi, which causes Lyme's disease, but the prevalence of infected ticks may be higher in certain areas. The risk of Lyme's disease is small if the tick is removed within 24 hours. Erythema migrans, the classical first stage of Lyme's disease, is treated with antibiotics depending on the clinical symptoms. A skin reaction that develops within a few days, that is smaller than 5 cm, and which disappears rapidly is a hypersensitivity reaction that is not caused by Lyme's disease. Serological investigations are only necessary if skin signs are unclear but tests are only sensitive enough to prove/disprove infection after 6 weeks. Post-exposure prophylaxis is not necessary after every tick bite but can be given if the tick has been attached for longer than 24 hours. Once-only administration of antibiotics reduces the risk of Lyme's disease.

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