Summary points

• Routine prophylactic antibiotic treatment of tick bites is not recommended—most ticks are unlikely to be infected with Borrelia burgdorferi, a bite from an infected tick may not cause human infection, and many human infections do not cause serious illness

• A negative history of tick bite does not exclude infection—establish whether there has been possible exposure to ticks and ask about risk associated with residence, work, recreational activities, pets, and holidays.

• Erythema migrans is the most common clinical presentation of Lyme borreliosis, and neurological presentations are probably the most common complications in Britain (chronic Lyme arthritis is uncommon in Europe but may be a major feature of infection contracted in North America)

• Lyme borreliosis responds well to adequate treatment with antibiotics, but full recovery may be slow with longstanding infections

• Negative antibody tests are rare in late stage Lyme disease, and alternative diagnoses must be rigorously investigated