Tick Bites: Easy to Miss
A patient once told me, “I check myself carefully — I would have seen a tick.” This is a common belief. But actually, tick bites are very easy to miss.
The ticks that most frequently spread Lyme disease aren’t large or obvious — they’re nymphs, smaller than a poppy seed and almost invisible on skin.
They don’t hurt when they bite and can hide anywhere: along the scalp, behind the knees, or under waistbands. Even adult ticks, though larger, are often overlooked. They’re flatter, darker, and can blend into moles or freckles — especially on the back, scalp, or behind the ear.
Like many patients, she couldn’t believe something so small could cause so much damage.
“Up to 70% of Lyme patients never saw the tick that infected them. The smallest bites can cause the biggest problems.”
Nymph and Adult Ticks: Tiny but Dangerous
Both nymph ticks and adult ticks can transmit Lyme disease.
Nymphs are responsible for most infections because of their size and timing — active in late spring and summer when people are outdoors hiking, gardening, or walking pets.
But adults, active in the fall and early winter, still pose a significant risk. Their bites may be dismissed as small scabs or freckles, particularly when they attach in hidden areas or beneath clothing.
Research suggests that most tick bites go completely unnoticed.
In a study of 1,770 children undergoing emergency department evaluation for Lyme disease, only about 30 percent recalled a tick bite — meaning up to 70 percent were missed entirely. Only a minority of children diagnosed with Lyme disease recall a preceding tick bite.
Didn’t See a Tick?
Ruling out Lyme disease because a tick wasn’t seen is a mistake. Ticks numb the bite area with anesthetic compounds and use anti-coagulants to stay attached silently.
Some patients develop a rash but never find a tick. Others have no rash at all. By the time fatigue, pain, or brain fog appear, the tick is long gone.
That’s why clinicians rely on a combination of history, symptoms, and testing — not just a visible tick — when diagnosing Lyme disease.
Lyme Disease Symptoms
Even without a visible tick bite, early signs of Lyme disease can include:
- Fatigue or flu-like malaise
- Headache or stiff neck
- Rash (sometimes—but not always—a bull’s-eye)
- Joint or muscle pain
- Brain fog, mood changes, or sleep issues
If these symptoms appear after outdoor activity, Lyme disease should always be considered.
Key Takeaway
Not seeing a tick doesn’t mean you weren’t bitten. Both nymph and adult ticks can transmit Lyme disease, and their bites are often missed.
If your energy, cognition, or joint health changed suddenly after outdoor exposure, trust your symptoms. Timely testing and treatment can prevent long-term complications.
Were you told you couldn’t have Lyme because you never saw a tick? Leave your thoughts in the comments below.
References
- Centers for Disease Control and Prevention. Epidemiology of Lyme Disease Diagnoses among Older Adults, United States, 2016–2019.
- Eisen RJ, Eisen L. The Blacklegged Tick, Ixodes scapularis: An Increasing Public Health Concern. Trends Parasitol. 2018;34(4):295–309.
- Falco RC, Fish D. Prevalence of Ixodes dammini Infestation on Humans in a Lyme Disease Endemic Area of New York State. Am J Epidemiol. 1988;128(5):1146–1152.
- Centers for Disease Control and Prevention. Lyme Disease Data and Surveillance. Updated 2024.
