New-ish Lyme Disease Prophylaxis

Thanks for the idea. I was bitten 3 times in the Rockies last year, and will admit to some concern about it. Fortunately nithnot came of it.

Couple weeks ago I pulled a tick out of my back – without knowing it was a tick. Put it in a plastic bag. The tick might have been there for 12 hours, but I’m pretty sensitive to tick bites, so probably much less. It wasn’t engorged.

When the bite swelled up hard, red, tender, and warm the next day, I took myself and the tick to urgent care. The doctor prescribed 200mg of Doxycycline, which I took in the parking lot of the pharmacy. The swelling went down over the next few days.

They analyzed the tick and didn’t find Lyme disease. Central California coast has lots of ticks, and some Lyme. I know several people who’ve gotten serious Lyme disease locally.

So Valerie’s doctor and my urgent care doctor both did not follow the CDC recommendations:

…when all of the following circumstances exist:

– Doxycycline is not contraindicated.
– The attached tick can be identified as an adult or nymphal I. scapularis tick.
– The estimated time of attachment is ≥36 h based on the degree of engorgement of the tick with blood or likely time of exposure to the tick.
– Prophylaxis can be started within 72 h of tick removal.
– Lyme disease is common in the county or state where the patient lives or has recently traveled, (i.e., CT, DE, MA, MD, ME, MN, NH, NJ, NY, PA, RI, VA, VT, WI).

Had I known that, I might have declined the antibiotic.

Or not. One previous tick bite was seriously infected, and antibiotics cured it. Wasn’t Lyme disease, probably staph according to that doctor. Ticks carry many human diseases, some of which are stopped by antibiotics.

More from the CDC:

Antibiotic treatment following a tick bite is not recommended as a means to prevent anaplasmosis, babesiosis, ehrlichiosis, or Rocky Mountain spotted fever …

No simple answers.

— Rex

Having had a rash that traveled down my leg at 4 inches per hour, followed by a lot of IV antibiotics and a week of Doxy – which makes me nauseous, btw – I tend to stick to the regimen of soaking clothing in permethrin every half dozen washes.

It wasn’t Lyme… but I don’t want any of them. (I was tested for the antibodies to Lyme, later when experiencing joint issues and a severe lower abdominal thing, and it was negative.)

Babesiosis (sp?) put one of my fellow trail crew in a hospital for a month. The ticks ain’t playin… Permethrin for me, do not want any rash/disease that a tick carries, regardless.

California is so behind on tick information and treatment. Most doctors still don’t believe you can get lyme in CA. That coupled with the poor testing methods makes things potentially dangerous for people bit.

The doc’s recommendation was based on an excellent study conducted years ago in New York State. 87% of those who took a single 200mg dose of doxy within 24 hours of removing a deer tick later tested negative for Lyme. It boggles the mind that this is not the standard of care, that little single-serve prophylactic doxy packs are not handed out in those areas where the disease is epidemic.

I always carry a bottle of doxy when overnighting in deer tick country.

87% of those who took a single 200mg dose of doxy within 24 hours of removing a deer tick later tested negative for Lyme. It boggles the mind that this is not the standard of care

Well, that might be good or it might be worthless.  It depends on what the percentage is for folks who removed a tick but didn’t take the doxy.  I’d expect the time between acquiring the tick and removing it to be a (more?) important factor.  Can you provide a link to the study?

Based on my recent experiences with antibiotics trashing my gut microbiome followed by months of distress, I’m far more convinced that they should be used for confirmed serious infections rather than “just in case.”

Everything has side effects and tradeoffs. HYOH.

— Rex

I heard a piece about ticks on NPR a few months back, and the take away was that you cannot get lyme if the tick is attached for less than 24 hrs (it might have been 36hrs, but was at least 24).  Something happens in the tick after that time that then makes it possible for lyme to transfer if it has it.

MYTH: You can only have Lyme disease if your tick has been attached at least 72 hours.

“A 2015 review article summarizes numerous animal studies showing infection of most animals by 72 hours, and of case reports citing infection within 6 hours or less of humans.[5] Added to this is the difficulty in knowing how long a very small tick has been attached, as the bite is painless and may go unnoticed. Other tick-borne infections can also be transmitted quickly. Anaplasma can be transmitted in a matter of a few hours of tick attachment.[6]

https://www.lymedisease.org/lyme-disease-myths/

Fact 3. Not all deer ticks are infected with the Lyme disease agent.

Only ticks that have fed on infected mammals (usually white-footed mice) are infected. About 50% of deer ticks are infected with Lyme disease.

https://blog.vermontcountrystore.com/deer-ticks/

A recently published, peer-reviewed study shows six different tick species carry Lyme disease in the United States, at rates ranging from 0.8% to 16.4%.

https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0199644

Rates in parentheses, first the average, followed by the 95% CI range.

And the CDC says:

Lyme disease cases are concentrated in the Northeast and upper Midwest, with 14 states accounting for over 96% of cases reported to CDC. Infected ticks can also be found in neighboring states and in some areas of Northern California, Oregon and Washington.

2016 Lyme disease reports by county.

It’s easy to get sucked down a tick-infested rabbit hole of Lyme disease web sites, some more reliable than others.

— Rex

Rex,

Great map.  Changes my misconceptions about where the ticks are.

The map doesn’t show where the ticks are; it shows where the disease was reported. To the best of my knowledge there are still no tick species that prey on humans in Alaska, and yet your map shows Lyme here. My bet is that they all traveled elsewhere to pick up their ticks and their case of Lyme. It is predicted that ticks will make their way here, but at the present moment my understanding is that our ticks prey mostly on hares, plus a few other wild animals. I have personally never seen a tick in Alaska, nor has anyone I know except for people who hunt hares.

Not looking forward to that changing!

A short course of Doxycycline for this is a pretty reasonable risk/reward trade-off. Doxycycline is relatively benign on most people especially in such a low dose. Its regularly prescribed for months and months on end to people as an anti-malarial for example (such as myself on a couple of long trips).

https://www.cdc.gov/lyme/treatment/index.htm

This one is a good read:

https://www.ncbi.nlm.nih.gov/pubmed/27115378

From it (and this is about prevention, prior to confirmation of onset of Lyme Disease. Once its confirmed, a 14 day 200mg Doxycline (or suggested alternatives) is undertaken):
<div class=”h4 cb section-type-section “>
<div class=”heading-text “>Disease Prevention</div>
</div>
<p class=”para”>There are no available human vaccines for Lyme disease, HGA, or babesiosis. A single 200-mg prophylactic dose of doxycycline following a tick bite was 87% effective in preventing the development of erythema migrans at the bite site,¹²⁷but the confidence interval surrounding this efficacy rate was wide. Prophylaxis is only recommended when an <i>Ixodes</i> tick from a Lyme disease–endemic area has been attached for 36 hours or longer and prophylaxis can be started within 72 hours.³The effect of single-dose prophylaxis with doxycycline on other <i>I scapularis</i>–transmitted infections is unknown.</p>
<p class=”para”><span class=”quizSection”>Current recommendations to reduce risk of transmission include daily body checks for ticks, use of tick repellents containing DEET, use of clothing impregnated with acaricides such as permethrin, and minimizing skin exposure to ticks.¹²⁸ Bathing or showering within 2 hours of tick exposure helps prevent attachment of ticks and reduces the odds of contracting Lyme disease, as does use of protective clothing.¹²⁹ Tick checks and use of tick repellents have yielded inconsistent results,¹²⁹^,130but adherence to these measures was not assessed, and failures may be attributable to lack of full adherence to preventive measures during exposures. Placing clothes in a dryer for up to 1 hour effectively kills ticks¹³¹ but has not been evaluated for reduction of Lyme disease cases. These interventions have minimal potential risks, so although they may have limited benefit, they can be recommended.</span></p>
<p class=”para”>Modifications of the home environment have not clearly been shown to affect transmission risk. Spraying pesticides around the home effectively reduces tick populations but is not associated with the incidence of Lyme disease.¹²⁹^,132 This discrepancy may be attributable to risks of exposure away from home. Alternatively, the decrease in tick numbers, while large, may need to be even larger to reduce risk of tick-borne diseases. Targeted application of acaricides to mice or deer has yielded mixed results¹³³^-136 or, in the case of the 4-poster device (a feeding station designed to apply acaricides), has raised concerns about the spread of other diseases such as chronic wasting disease in deer. Altering landscape characteristics by removing leaf litter or having a barrier to adjacent wooded areas has not consistently reduced the incidence of Lyme disease.¹²⁹</p>