Intended for healthcare professionals

Clinical Review

Tick bite prevention and tick removal

BMJ 2013; 347 doi: (Published 09 December 2013) Cite this as: BMJ 2013;347:f7123
  1. Christina Due, research scientist12,
  2. Wendy Fox, founder of Borreliosis and Associated Diseases Awareness UK2,
  3. Jolyon M Medlock, head of medical entomology3,
  4. Maaike Pietzsch, senior project scientist, medical entomology and zoonoses ecology3,
  5. James G Logan, senior lecturer in medical entomology12
  1. 1Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK
  2. 2Borreliosis and Associated Diseases Awareness UK (BADA-UK), Wath upon Dearne, Rotherham, UK
  3. 3Public Health England, Porton Down, Salisbury, UK
  1. Correspondence to: J G Logan James.Logan{at}
  • Accepted 20 November 2013

Summary points (advice for patients)

  • When outdoors check for ticks every 2-3 hours and promptly remove them; self examine the body after being in a tick infested area

  • Wear appropriate clothing—long trousers with socks tucked in and shirts tucked into trousers

  • Use permethrin treated clothing and a repellent containing PMD or DEET in tick infested areas

  • Use fine tipped forceps to remove ticks, grasping the tick close to the skin and pulling steadily without twisting

  • If bitten, report symptoms such as rash, unexplained headache, facial palsy, or arthralgia to your GP

  • If bitten in a Lyme disease endemic area, consult your GP to discuss antibiotic prophylaxis

Ticks are small blood feeding ectoparasites with a global distribution. They are important vectors of disease pathogens including rickettsiae, spirochaetes, and viruses. Prevention of tick attachment and rapid removal reduce the risk of contracting tickborne diseases, and there are many recommendations on how to achieve this. This article aims to review the evidence base for tick bite prevention and tick removal strategies.

What is a tick?

Ticks are arachnids and can be divided into two families known as Ixodidae (hard ticks) and Argasidae (soft ticks). Hard ticks have a shield-like scutum on their dorsal side and visible mouthparts that protrude forward. Soft ticks lack a scutum and their mouthparts are located on the underside and are therefore not visible. Hard ticks have a three stage life cycle, comprising larval, nymph, and adult stages, whereas soft ticks have two or more additional nymph stages. Larval hard ticks are typically 0.5 mm long (the size of a poppy seed) and have six legs. Nymphal ticks are about 1.5 mm long and adult unfed ticks are about 3 mm long, although once fed they can enlarge to 11 mm in length (fig 1). Both nymphs and adults have eight legs. Tick coloration varies between species, …

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