You find it after a walk at Wickford Village, or after the dog comes in from the yard. A small dark speck on the back of your knee that wasn't there this morning.



If you live in Washington County, this isn't a rare event. Rhode Island reported 2,563 cases of Lyme disease in 2024, and Washington County had the highest rate in the state at 723 cases per 100,000 people. That's roughly three times the statewide rate. North Kingstown sits right in the middle of it.

How to remove a tick, step by step

Speed matters more than technique, but technique still matters. Work through these in order.

Step 1. Get fine-tipped tweezers. Regular tweezers work if that's what you've got, and clean fingers work in a pinch. What you're after is a grip precise enough to catch the tick without squeezing its body.

Step 2. Grip as close to your skin as possible. You want the tweezers on the tick's head, right where it meets the skin, not on the swollen back end.

Step 3. Pull straight up, slowly and steadily. Even pressure. No twisting, no jerking, no wiggling. Twisting is what snaps the mouthparts off and leaves them behind.

Step 4. If a fragment stays in, leave it. Make one gentle attempt with the tweezers. If it doesn't come free, stop. Your skin will push it out over the next few days, and digging around does more damage than the fragment does.

Step 5. Clean the bite and your hands. Soap and water, rubbing alcohol, or hand sanitizer. All three are fine.

Step 6. Identify the tick. The University of Rhode Island TickEncounter has a free program where you can send a photo of the tick and receive tick identification and likely riskiness. They also can help with testing for pathogens for a fee. 

Step 7. Write down the date. Everybody skips this one, and it's the one that matters most later. The clock on your treatment options starts the moment the tick comes off.

What not to do

The CDC is direct about this.

Skip the folk remedies entirely:

• No petroleum jelly
• No nail polish
• No lit match or any other heat source
• No crushing it with your fingers

None of these make a tick let go. What they do is buy the tick more time while you're waiting for them to work, and attached time is the whole ballgame.

The 72-hour window

For a bite that meets specific criteria, a single 200 mg dose of doxycycline can meaningfully reduce your chance of developing Lyme disease. But the treatment guidelines from the Infectious Diseases Society of America are narrow about when it applies.

All three of these have to be true:

• The tick was a deer tick, not a dog tick or a lone star tick
• It had been attached at least 36 hours, judged by how engorged it looks or by when you know you were exposed
• You're in a high-incidence area, which Rhode Island firmly is and the dose has to start within 72 hours of pulling the tick off.

That last line is the reason we wrote this. Not 72 hours from when you notice a rash. Not 72 hours from when you finally get an appointment. Seventy-two hours from removal.

The 36-hour threshold isn't arbitrary either. The bacteria that causes Lyme lives in the tick's gut, and moving into a host takes it time. Transmission rarely happens before the 36 to 48 hour mark. That's why a tick you find and pull off the same evening carries far less risk than one that rode home on you three days ago.

If your bite doesn't clear all three bars, the guidelines actually recommend watching rather than treating. Antibiotics aren't the automatic answer here. But somebody has to look at the tick and ask the right questions, and that has to happen fast.

Why the traditional system misses this

Think through how this usually goes.

You pull the tick off on a Thursday after an afternoon walk. You call your primary care office, but the first opening is a week and a half out. So you either wait, and the window quietly closes, or you sit in an urgent care waiting room on a Sunday afternoon and pay out of pocket to see someone who's never met you and has no idea what your last five years looked like.

Neither of those is a good outcome for a problem this small.

At Rhode Island Direct Primary Care, our members reach us directly by phone, text, or email from Monday-Friday, 9am - 8pm). A tick bite gets an answer the same day, while the answer is still worth having. We can look at the tick, ask about attachment time, and decide together whether prophylaxis makes sense for you or whether watching is the better call.

That's what the membership buys. Not a nicer waiting room. Access at the moment, access changes the outcome.

Watch for 30 days

Whether or not you take anything, keep an eye on the bite site and on how you feel for the next month.

Call us if you notice:

• An expanding red rash, with or without a clear center. It doesn't always look like a bullseye
• Fever, chills, headache, or aching muscles and joints
• Deep fatigue that arrives without explanation
• A stiff neck, or facial drooping on one side

The rash matters most. If you've been around ticks and you develop a rash consistent with erythema migrans, that's enough for a diagnosis on its own. No blood test required.

Testing an asymptomatic person right after a bite actually isn't useful, because antibodies take weeks to build. A negative result that early tells you nothing at all, and plenty of people walk away from it falsely reassured.

Sending the tick itself out for testing has the same problem. A tick carrying Lyme bacteria doesn't mean it passed anything to you, and a clean result doesn't rule out a second bite you never found. We treat the person, not the insect.

Lyme isn't the only thing ticks carry here

Deer ticks in Rhode Island also transmit anaplasmosis and babesiosis, and Washington County leads the state in those too. In 2024, the county reported babesiosis at 38.5 cases per 100,000 people, with eighty percent of cases landing between June and August.

Neither illness produces the telltale rash. Both tend to show up one to two weeks after a bite as fever, headache, chills, and body aches, which is to say they look like a summer flu that showed up in the wrong season. If you feel that way in the weeks after a tick bite, mention the bite. It changes what we look for.

Staying ahead of it

Ticks in Rhode Island peak in July, but adults stay active well into the fall and again on any mild winter day. Prevention is worth the effort a lot longer than most people assume.

Treat boots and outdoor clothing with permethrin, which survives several washes. Use DEET or picaridin on exposed skin. Walk the middle of the trail at

Ryan Park or the Great Swamp instead of brushing through the tall grass along the edges, because that edge habitat is where ticks wait.

When you get home, put your clothes straight into a hot dryer for ten minutes. Heat kills ticks better than washing does, and a warm wash cycle won't do it.

Then check yourself that same night. Behind the knees, around the waistband, along the hairline, under the arms, between the legs. Get someone to check your back. Nymphal ticks are the size of a poppy seed, and their bite doesn't itch or hurt, which is exactly how they end up attached for 36 hours without anyone noticing.

Check the kids and the dog too. Dogs bring ticks indoors that then find their way onto people.

Talk to us before the clock starts

The people who handle tick bites well are usually the ones who already know who to call.

If you're in North Kingstown, Wickford, Saunderstown, or anywhere in South County and you want a provider you can actually reach, schedule a Meet and Greet with Rhode Island Direct Primary Care. No cost, no obligation. Just a conversation about what having real access to your doctor would look like.

References

• Centers for Disease Control and Prevention. What to Do After a Tick Bite. https://www.cdc.gov/ticks/after-a-tick-bite/index.html
• Rhode Island Department of Health. Tickborne Disease Data. https://health.ri.gov/data/tickborne-disease-data
• Infectious Diseases Society of America, American Academy of Neurology, and American College of Rheumatology. Clinical Practice Guidelines for the Prevention, Diagnosis and Treatment of Lyme Disease. https://www.idsociety.org/practice-guideline/lyme-disease/