UKHSA confirmed 1,168 UK Lyme disease cases in 2025 – the peak risk months are June and July across the Scottish Highlands, South West, South East, East Anglia, the New Forest and the Lake District.

Lyme Disease UK 2026: NHS Tick Bite Season in June – What to Do, How to Remove a Tick, and When to See the GP

You have just come back from a June walk in the New Forest or up in the Scottish Highlands. In the shower, you notice a small dark dot embedded in the back of your knee. You Google “tick UK Lyme” and the internet panics you with horror stories. Take a breath. This guide is calm, UK-anchored and written the way a GP would talk you through it in the surgery. We will walk through what Lyme disease actually is, where in the UK the risk is highest in 2026, exactly how to remove a tick safely using the NHS step-by-step method, what the bullseye rash looks like and when it appears, the NICE NG95 NHS pathway that allows your GP to treat you from the rash alone without waiting for a blood test, what doxycycline treatment involves, and how to prevent bites during the June and July peak.

What Lyme disease is and how common it is in the UK in 2026

Lyme disease, also called Lyme borreliosis, is a bacterial infection caused by Borrelia burgdorferi. It is transmitted to humans through the bite of an infected Ixodes ricinus tick, commonly known as the sheep tick or castor bean tick, which is the most common tick species found across the UK. An important point to hold on to: not all ticks carry the bacteria. The proportion of ticks that are infected varies by location, but in higher-risk UK regions it is typically around 5 to 15 percent. Even if you are bitten by a tick in a high-risk area, most bites do not result in infection.

There is a further reassurance built into the biology. The tick needs to be attached to your skin for several hours, usually around 24 to 36 hours, before it can transmit Borrelia. This is why prompt tick removal is so effective at reducing your risk. A tick that is found and removed within a few hours of attachment is very unlikely to have passed on the infection.

UKHSA reported 1,168 laboratory-confirmed acute Lyme disease cases in England in 2025, up from 959 in 2024. The estimated true incidence, including cases that were never diagnosed or tested, is thought to be around 2,000 to 3,000 cases per year across England and Wales. Tick season in the UK runs from April through to October, but June and July are the highest-risk months because that is when grass growth is at its peak, temperatures are warm enough for tick activity, and the most people are outdoors. Climate change is gradually extending the tick season at both ends of the year.

High-risk areas in the UK include the Scottish Highlands, particularly the Spey valley, South West England including Exmoor, Dartmoor and Salisbury Plain, South East England, parts of East Anglia, the South Downs, the New Forest, the Lake District and parts of the Peak District. Even some urban parks with dense vegetation, such as Richmond Park and Bushy Park in London, are known to have ticks. UKHSA notes that around 70 percent of confirmed cases were reported from the South West, South East and London, though this figure partly reflects testing patterns rather than necessarily where the tick bites occurred. Most UK Lyme disease cases are treated successfully in primary care and have a good outcome.

How to remove a tick safely – the NHS step-by-step method

Finding an embedded tick on your skin can feel unsettling, but removal is straightforward when you follow the NHS guidance. The key is to act promptly and to use the right technique.

First, use the right tool. A purpose-made tick removal tool, such as an O’Tom Tick Twister or Ticked Off, is ideal. Fine-pointed tweezers also work well. Avoid blunt household tweezers, which can crush the tick rather than gripping it cleanly. Grip the tick as close to the surface of your skin as possible, right where the mouthparts enter. Pull steadily upward with even pressure. Do not twist, jerk or squeeze the tick’s body. Squeezing can compress the tick’s gut contents and push infected saliva into the wound, which actually increases your risk of contracting Lyme disease rather than reducing it.

Once the tick comes away, clean the bite area with soap and water or an antiseptic wipe. Now, resist the urge to use any of the old folk remedies you may have heard about. Do not apply a lit match. Do not smother the tick with petroleum jelly, nail polish or essential oils. Do not pour alcohol or hand sanitiser over it. All of these methods can distress the tick and cause it to regurgitate into the wound, which again raises your infection risk rather than lowering it. None of them are recommended by the NHS.

After removal, note the date and the time if you can. Take a quick photograph of the bite area on your phone. If it is practical to do so, keep the tick itself: tape it to a piece of paper or seal it in a small plastic bag, label it with the date, and hold on to it for four to six weeks. This can help with identification if you later develop symptoms and your GP needs more information.

It is worth knowing what you are looking for. UK Ixodes ticks range from poppy-seed size in the nymph stage, which is the stage most likely to bite humans, to grain-of-rice size in adult females once they have started to engorge with blood. They are usually brown or black, sometimes reddish-brown. After a country walk, always check the back of your knees, your groin, your armpits, your scalp and hairline, behind your ears, and your waistline. These are the warm, sheltered spots that ticks prefer.

Finally, routine antibiotic treatment immediately after a tick bite is not recommended on the NHS. The standard UK approach is to watch and to treat if symptoms develop.

The bullseye rash and other early symptoms to watch for

The most distinctive sign of Lyme disease is a rash called erythema migrans. Around 60 to 80 percent of people who develop Lyme disease in the UK will get this rash. It typically appears between 3 and 30 days after the tick bite, most often within 1 to 4 weeks, and it appears at or near the site of the bite.

The rash is round or oval and it gradually expands, often reaching 5 cm or more in diameter over several days. It frequently has a paler centre, which gives it the classic “bullseye” appearance that you may have seen in photographs. However, it is important to know that erythema migrans does not always look like a bullseye. In some cases it appears as a uniform red, pink or purple patch without a pale centre. Either pattern is consistent with a clinical diagnosis of Lyme disease under NICE NG95.

One helpful distinguishing feature is that erythema migrans is usually not itchy and not painful. This sets it apart from most insect bites, eczema and other common skin reactions, which tend to itch. If you notice an expanding red patch at a tick bite site that does not itch, that is a strong reason to contact your GP.

Around 20 to 30 percent of Lyme disease cases, however, do not develop a visible rash. This is more likely when the bite is in the scalp or another area that is hard to see. In these cases, the early symptoms to watch for include flu-like illness without a cough, fever, headache, fatigue, aching muscles and joints, swollen glands near the bite site, and sometimes a stiff neck. These symptoms typically appear 1 to 4 weeks after the bite. The classic clinical clue is flu-like illness in summer in someone who has recently been outdoors in a tick-risk area.

Without treatment, around 10 to 15 percent of people with Lyme disease develop later complications weeks or months after the initial infection. These include Lyme arthritis, particularly affecting the knee, neurological Lyme such as facial nerve palsy or meningitis-like symptoms, and rarely cardiac involvement such as heart block. These complications are largely preventable with early antibiotic treatment, which is why prompt recognition matters.

The NHS pathway – NICE NG95, the GP appointment and doxycycline treatment

NICE NG95, the Lyme disease clinical guideline published in 2018 with subsequent updates, is the framework your GP will use in 2026. Understanding its key principles can take much of the anxiety out of the process.

The single most important point is this: if you present to your GP with erythema migrans, your GP should diagnose Lyme disease clinically and start antibiotics straight away, without waiting for a blood test. This is not a shortcut or a guess. It is the recommended NICE pathway, because blood tests for Lyme disease are not reliable in the first four weeks of infection. Antibodies take time to develop in the body, and a test taken too early can give a false negative result. Waiting for a blood test in the presence of a characteristic rash would delay treatment without adding useful information.

If you have symptoms that suggest Lyme disease but there is no visible rash, your GP will request an ELISA antibody test, often a C6 ELISA, as the first-line investigation. If the result comes back negative but it is still within four weeks of symptom onset, and your GP still suspects Lyme disease, the test will be repeated at four to six weeks. If the ELISA is positive, a confirmatory immunoblot test is carried out. For complex, late-stage or atypical presentations, specialist referral may be arranged.

Treatment follows a clear pattern under NICE NG95. The first-line antibiotic for adults and adolescents with erythema migrans or early Lyme disease without complications is oral doxycycline 100 mg taken twice daily for 21 days. This is a well-established, widely used antibiotic. If doxycycline is unsuitable, for example during pregnancy, breastfeeding, or for children under 12, the alternatives are amoxicillin 1 g three times daily for 21 days, or azithromycin 500 mg once daily for 17 days. For Lyme arthritis, the course is extended to 28 days of doxycycline. For neurological Lyme disease, oral doxycycline for 21 days is standard, with intravenous ceftriaxone reserved for severe cases.

Treatment started within the first four weeks of infection is highly effective. The erythema migrans rash typically fades within two weeks of starting antibiotics. Most people make a full recovery. A small number of people experience persistent symptoms such as fatigue or joint aches after treatment, sometimes referred to as post-treatment Lyme disease symptoms. These are recognised within the NHS and can be managed through specialist assessment if they persist.

Preventing tick bites in June 2026 – what works

June and July 2026 represent the peak of UK tick season. If you are planning walks in the countryside, there are several straightforward, evidence-based steps that dramatically reduce your chance of being bitten.

Start with clothing. Wear long trousers tucked into your socks when walking through long grass, woodland or moorland. This is not a fashion statement, but it is genuinely the single most effective physical barrier against tick bites. Choose light-coloured clothing if you can, because ticks are much easier to spot against a pale background than against dark fabric.

Next, use an insect repellent containing DEET at 20 to 30 percent concentration, or picaridin, on any exposed skin. Both are effective against UK ticks and are widely available from pharmacies and outdoor retailers. Apply before you set out and reapply as directed on the product label.

Stay on cleared paths where possible. Ticks tend to be concentrated in vegetation at ground level, particularly in long grass, bracken and leaf litter. Avoid sitting directly on the grass at lunch stops; bring a mat or sit on a dry stone wall instead.

When you get home, shower within two hours and check yourself thoroughly. Ticks often crawl for an hour or two before they find a spot to attach, so a prompt shower removes many ticks before they have even begun to feed. Check children and dogs carefully as well.

Wash outdoor clothes on a hot cycle at 60 degrees Celsius or above to kill any unseen ticks. Tumble drying is also effective. Carry a tick removal tool in your walking kit so that you are prepared if you do find one attached.

For dog owners, brushing your dog vigorously outdoors before going inside can help dislodge ticks before they enter the home. A veterinary tick collar or tick treatment reduces the number of ticks your dog brings in. Check the UKHSA Tick Surveillance Scheme data if you are visiting an unfamiliar area and want to understand the local tick risk. Children should be checked carefully after every country walk, with particular attention to the scalp, hairline, behind the ears and the back of the knees. Teach older children to do their own check at the end of an outdoor day.

Children, pregnancy and dog owners – special situations

Children

The scalp, hairline and behind the ears are the most common tick bite sites on children. This is because children’s heads are closer to grass height than adults, and ticks climb upward to find a feeding site. Check children carefully after every country walk, and make it part of the post-walk shower routine.

Tick removal in children follows the same NHS method as in adults: use fine tweezers or a tick removal tool, grip close to the skin and pull steadily upward. Reassure your child calmly. The procedure looks worse than it usually feels, and most children tolerate it well.

A specific treatment difference to be aware of: doxycycline is not licensed for children under 12 in the UK. If your child develops erythema migrans, your GP will prescribe amoxicillin instead, at a dose of 50 mg per kg of body weight per day in three divided doses for 21 days. Children with erythema migrans should be treated empirically under NICE NG95 in exactly the same way as adults, without waiting for a blood test.

Pregnancy and breastfeeding

Doxycycline is not recommended in pregnancy or during breastfeeding. The first-line antibiotic for pregnant women with Lyme disease is amoxicillin 1 g three times daily for 21 days. If you are pregnant and develop a suspicious rash or flu-like illness after a tick bite, mention the tick exposure to both your midwife and your GP. Untreated Lyme disease in pregnancy carries a small but real risk to the baby, and prompt antibiotic treatment is the safe and recommended course of action.

Dog owners

Dogs can bring ticks into the home on their fur, including into your bed if that is where your dog sleeps. A tick collar or a veterinary tick treatment dramatically reduces this risk. Speak to your vet about the best current product for your area and your dog’s lifestyle.

It is reassuring to know that Lyme disease cannot be passed from dog to human directly. The transmission route is always via a tick bite. However, dogs can also develop Lyme disease themselves, typically presenting as lameness or joint swelling, and they benefit from prompt veterinary attention if these symptoms appear. Check your dog daily for ticks during peak season, particularly around the head, neck, ears, armpits and groin. A two-minute daily tick check is a small habit that protects both your dog and your household.

Frequently Asked Questions

How long does a tick need to be attached to transmit Lyme disease?

Most evidence suggests that Borrelia burgdorferi needs several hours of tick attachment to transmit, usually around 24 to 36 hours. This means prompt removal substantially reduces your risk of infection. Even if you find an embedded tick, the chance of Lyme transmission is low if removal happens within the first few hours. Always note the date of removal and watch the bite area for 30 days. Do not panic about a brief attachment, but do remove the tick promptly using the NHS step-by-step method.

Do I need antibiotics straight after a tick bite, just in case?

No. Routine antibiotic prophylaxis after a tick bite is not recommended on the NHS. The standard UK approach is to watch and to treat if symptoms develop. Most tick bites do not transmit Lyme disease. Remove the tick, clean the bite, note the date and watch for a rash or flu-like symptoms over the next 30 days. If you develop the characteristic expanding rash or feel unwell, see your GP and mention the tick bite. Your GP can then treat empirically under NICE NG95.

What does the bullseye rash look like?

Erythema migrans is round or oval, gradually expanding to 5 cm or more in diameter, and often has a paler centre giving a “bullseye” appearance. It can also be a uniform red, pink or purple patch without a pale centre. It is usually not itchy or painful, which distinguishes it from most insect bites or skin reactions. It typically appears 3 to 30 days after the bite, most often within 1 to 4 weeks. Take a photograph with a coin for scale and show it to your GP. Under NICE NG95, this rash is sufficient for a clinical diagnosis.

Can my GP diagnose Lyme disease without a blood test?

Yes. If you have erythema migrans, NICE NG95 states that your GP should diagnose Lyme disease clinically and prescribe antibiotics without waiting for a blood test. Blood tests are unreliable in the first four weeks because antibodies take time to develop in the body. If your symptoms suggest Lyme disease but there is no rash, your GP will request an ELISA antibody test and may repeat it at four to six weeks if the first result is negative and Lyme disease is still suspected.

How effective is treatment, and how quickly does it work?

Early Lyme disease treatment with 21 days of doxycycline 100 mg twice daily, or amoxicillin or azithromycin if doxycycline is unsuitable, is highly effective when started within the first four weeks of infection. The erythema migrans rash typically fades within two weeks of starting antibiotics. Flu-like symptoms usually settle within days. A small number of people experience post-treatment symptoms such as fatigue or joint aches lasting weeks or months. This is a recognised condition and is managed through NHS specialist assessment if symptoms persist.

I removed a tick yesterday and feel fine – do I need to see the GP?

Not immediately. If you removed the tick promptly and currently have no symptoms, the standard UK approach is to watch the bite area for 30 days. Take a photograph of the bite now as a reference. Over the coming weeks, watch for an expanding round or oval rash, or for flu-like symptoms such as fever, headache, fatigue, aching joints or swollen glands. If either appears, see your GP within 24 to 48 hours and mention the tick bite. If you remain well after 30 days, no further action is needed.

This article is informational only and does not replace personalised advice from your GP, pharmacist, or another qualified healthcare professional.