Spring is tick season. Here’s how to avoid Lyme disease.

Published 3/27/2023 5:30 a.m. EDT

A deer tick in a yard as a child is playing.

Ah, spring. The season of daffodils, new beginnings, and the emergence of everyone’s favorite blood-sucking arachnid, the tick — just waiting for the chance to gorge itself as you engage in your favorite outdoor activities.

As if hacking into tender human flesh with its harpoon mouth wasn’t enough, the scourge of the spider family can also transmit Lyme disease and other illnesses. If not treated, Lyme can cause serious or even life-threatening complications down the road, and chronic symptoms can sometimes linger even with treatment.

Incidences of Lyme disease have nearly doubled in the U.S. over the last three decades, due to changes in climate and land use patterns, as well as globalization.

The Banner spoke with Dr. John Aucott, director of the Lyme Disease Research Center at the Johns Hopkins University School of Medicine, about what Lyme is, how it spreads, and how to protect yourself.

The conversation has been edited for brevity and clarity.

Banner: What is Lyme disease, and how does it affect the body?

Aucott: Lyme is an infectious disease that’s caused by the bacteria Borrelia burgdorferi, which is transmitted to humans through the bite of an infected deer tick. The bite often, but not always, causes a round, red skin lesion to form. In more than half of people who are infected, if they aren’t treated at that early stage, the bacteria will spread and can cause later infections of other organs, notably the heart, the nervous system, and the joints.

In what types of environments are people most likely to contract Lyme disease, and what are the best prevention strategies they can use?

Unfortunately, Baltimore and the counties surrounding it are high-risk areas for Lyme transmission because we have green spaces that support deer and ticks and mice, which carry the infection, with people living, gardening, or recreating in those areas. This includes areas in the city limits where there’s streams and greenways, and definitely outside the city in reservoir and hiking areas.

Most Lyme disease is actually transmitted in your own backyard, in the woods outside of your lawn. Gardening in the springtime is the classic time to get tick bites because you’re out cleaning brush at the edge of your lot, and that’s where the ticks live.

The way to prevent it is to dress appropriately, which includes wearing long pants with shoes and socks, and the clothing can be treated with a chemical called permethrin, which you can buy in sports stores. You can also use compounds on your skin: The best-known one is DEET, but there’s others you can find on the CDC website.

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After gardening or hiking, take a shower while looking and feeling for ticks. Nymph-stage or adolescent ticks are the size of a poppy seed, so they’re hard to see. It can be easier to find them by feeling for them in areas where they like to attach, like behind your knee or in the groin, armpit or other areas that you may not be able to see. If you remove the tick quickly, it dramatically lowers the risk of transmitting the bacteria.

During what times of year are people most at risk of getting infected?

Nymph-stage ticks come out in late spring and early summer, and peak months are always June and July. There’s a second small peak in fall when the adult-stage ticks are feeding and people are spending time outside. Transmission dips in August when it’s really hot and both people and ticks aren’t out as much, and then it dips a lot after it gets really cold because adult ticks won’t feed when the temperature is below 40°. But with warming climates we actually do see tick bites in winter if the temperature is above 40 degrees.

What symptoms of Lyme should people watch for?

Acute Lyme disease has an incubation period of a couple weeks, so it occurs about 1-3 weeks after the tick bite. People should be looking for that round, red skin lesion, and one of the huge take-home points I always tell people is it usually doesn’t look like a target — like the side of a Target department store. That classic bull’s-eye shape only appears in 20% of the skin lesions. The majority are actually just round and red, and they’re commonly mistaken for a bug or spider bite.

People miss the opportunity to get a doctor to check it out because they may not have any symptoms. Or they may have symptoms like fever, chills, fatigue and achiness, sort of like the flu, but without the respiratory symptoms. That accompanies a rash a lot of the time, but not always. Sometimes the rash is the only thing that appears in the acute phase in the first several weeks after the tick bites.

What is chronic Lyme?

Chronic Lyme is a misunderstood term, and it’s confusing because an infectious disease doctor defines Lyme disease by its three stages. If the first stage is not treated with antibiotics, a high percentage of people will go on to develop later manifestations of the untreated infection.

The first stage is the rash and other symptoms, like fever. The second stage is a manifestation of ongoing infection when the bacteria spreads to either the heart, the nervous system, or the joints. Rarely, heart involvement can be fatal.

Then, if that stage is not recognized and treated, the third stage occurs an average of six months later. That’s when Lyme arthritis occurs. Lyme disease was actually discovered from an outbreak of Lyme arthritis in kids in a town called Lyme, Connecticut.

All three stages are manifestations of untreated bacterial infection. That’s not what people are usually talking about when they use the words chronic Lyme disease, though — they’re referring to the ongoing symptoms like fatigue, brain fog, and joint pain that can occur months after the initial infection, even when the person has been previously treated.

It’s hard to understand why those chronic persistent symptoms occur because the link between the bacteria and those symptoms is an area of ongoing research. It’s not yet clear — especially in people who have already been treated with antibiotics — whether those chronic symptoms represent ongoing infection or are due to infection-triggered processes like autoimmunity, persistent inflammation, or changes in systems that were triggered by the infection. This is similar to ongoing questions about what causes long COVID, which is also still in the research phase.