Tick Bites & Lyme Disease in Ireland — Patient Guide

Tick bites in Ireland

Ticks are small arachnids found in long grass, woodland, and heathland across Ireland. The most common species — Ixodes ricinus — can transmit Lyme disease (Lyme borreliosis). Per HSE/HPSC surveillance, around 200-400 confirmed cases of Lyme disease are reported in Ireland per year, with under-reporting likely. Highest risk areas include Wicklow, Killarney, Donegal forests, and other woodland/upland zones. Risk is highest April-October.

Important: most ticks do not carry Borrelia bacteria (the cause of Lyme), and even when they do, prompt tick removal significantly reduces transmission risk.

Recognising a tick bite

• Small dark spot attached to skin — may be tiny (size of a pinhead) to larger (after feeding)
• Often painless — many people don't feel the bite
• Common locations: behind knees, groin, armpits, scalp, behind ears, waistline — warm, soft skin areas
• After full body check needed after outdoor activity in long grass or woodland

How to safely remove a tick

Per HSE guidance:

• Use fine-tipped tweezers or a purpose-made tick remover
• Grasp the tick as close to the skin as possible
• Pull upwards with steady, even pressure — don't twist or jerk
• Don't use heat, petroleum jelly, or alcohol — these can cause the tick to regurgitate, increasing infection risk
• Clean the bite area with soap and water or antiseptic
• Wash your hands
• Note the date — useful if symptoms develop later

Removed ticks can be kept (in a sealed bag) for identification if symptoms develop.

Lyme disease — the early rash

The most characteristic early sign of Lyme disease per NICE CKS:

• Erythema migrans — an expanding circular or oval red rash appearing 3-30 days after the bite (typically week 1-2)
• Usually larger than 5 cm across
• Often a "bullseye" appearance — but can be solid red
• Usually painless, sometimes warm or itchy
• Expands outward over days/weeks
• Sometimes accompanied by flu-like symptoms — fatigue, headache, muscle aches, fever

If you see this rash within 3 months of a tick exposure or outdoor activity in known tick areas — see an Online Doctor or in person promptly. Early antibiotic treatment is highly effective.

Treatment

Per NICE and HPSC guidance:

• Erythema migrans + clinical history — usually sufficient for diagnosis. Antibiotic treatment (typically doxycycline 21 days for adults; amoxicillin or other for children/pregnancy) is highly effective
• Blood testing for Lyme is useful when erythema migrans is absent but other Lyme features are present — though early in infection (first 4-6 weeks) tests can be falsely negative
• Late Lyme disease (joint, neurological, cardiac involvement weeks-months later) needs specialist input — usually infectious diseases or rheumatology

Prevention

• Long sleeves and long trousers in tick areas, tucked into socks
• Light-coloured clothing to spot ticks
• Insect repellent containing DEET or picaridin
• Stay on marked paths in woodland
• Full body tick check after every outdoor activity in tick areas — look at scalp, behind ears, neck, armpits, groin, behind knees
• Shower and change clothes after outdoor activity
• Check pets — they can bring ticks indoors

Online Doctor consultation

An Online Doctor consultation is appropriate for: assessing an erythema migrans rash via photograph, prescribing antibiotic treatment, advice after a tick bite without rash, prevention guidance. For complex presentations or suspected late Lyme disease, specialist referral is appropriate.