Can You Get Lyme Disease in the Southern United States?

Lyme disease risk is expanding in parts of the South
Several southern tick species can transmit human disease
Travelers should not assume winter or southern climates are risk-free

Lyme disease in the Southern United States is less common than in the Northeast and upper Midwest, but blacklegged ticks and reported Lyme disease cases have expanded into parts of Virginia, North Carolina, and neighboring Appalachian regions.

The risk is not limited to Lyme disease. The Southern United States is home to several medically important ticks, including the lone star tick, blacklegged tick, American dog tick, and Gulf Coast tick. These ticks may transmit or be associated with diseases such as ehrlichiosis, Rocky Mountain spotted fever, anaplasmosis, babesiosis, tularemia, STARI, alpha-gal syndrome, Heartland virus, Bourbon virus, and Lyme disease.

A 2024 study of tick encounters in the southeastern United States found that tick activity varies by species and season. Lone star ticks and American dog ticks were more likely to be encountered in spring and summer, while blacklegged ticks were more likely to be encountered in autumn and winter. [1]

Quick summary: Although Lyme disease remains less common in much of the South than in the Northeast, clinicians should also consider ehrlichiosis, Rocky Mountain spotted fever, STARI, alpha-gal syndrome, and other tick-borne illnesses after tick exposure in southern states.

Are there ticks in the South?

Yes. Ticks are common throughout the Southern United States. A 2024 study using tick encounter data from forestry crews in the southeastern United States found that three important human-biting ticks — Amblyomma americanum (lone star tick), Dermacentor variabilis (American dog tick), and Ixodes scapularis (blacklegged tick) — were encountered across multiple southeastern states. [1]

The study found that tick activity varied by species and season. Lone star ticks and American dog ticks were more likely to be encountered in spring and summer, while blacklegged ticks were more likely to be encountered in autumn and winter. [1]

This seasonal difference is important for patients and travelers. A tick bite in the South during the colder months should not automatically be dismissed as low risk, especially when the tick is a blacklegged tick.

Can Lyme disease occur in the Southern United States?

In Virginia, the number of Lyme disease cases has expanded significantly, particularly in the southern regions. The study, Geographic Expansion of Lyme Disease in the Southeastern United States, 2000–2014, examined confirmed and probable Lyme disease cases in Virginia and North Carolina over a 14-year period. [2]

Researchers found “a marked increase in Lyme disease cases in Virginia, particularly from 2007 onwards … with development of a new disease cluster in the southern Virginia mountain region.” They also reported that five counties in North Carolina had been considered endemic for Lyme disease since 2009. [2]

According to the authors, “we may also see expansion into the mountainous areas of neighboring states, such as Kentucky, West Virginia, and Tennessee” in the coming years. [2]

The study also analyzed public health data from Virginia and North Carolina on more than 11,000 Lyme disease cases reported over a 15-year period. The authors concluded, “The trends in these data paint a clear picture of southward expansion of Lyme disease.” As a result, communities once considered non-endemic for Lyme disease may be at risk, including parts of the southeastern United States. [2]

Why is Lyme disease less common in much of the South?

Lyme disease is generally reported less often in much of the South than in the Northeast. Several factors may contribute, including differences in tick behavior, host preferences, infection prevalence, climate, habitat, and human exposure patterns.

However, lower reported incidence does not mean Lyme disease is absent. Blacklegged ticks are present in southern states, and Lyme disease risk has expanded in parts of Virginia, North Carolina, and neighboring regions. Patients with compatible symptoms after a tick bite or outdoor exposure should be evaluated based on the full clinical picture, not geography alone.

For more information on symptom patterns after exposure, see Lyme disease symptoms and Lyme disease test accuracy.

Which ticks live in the Southern United States?

Several tick species in the South may bite humans and transmit disease. The most important include the lone star tick, blacklegged tick, American dog tick, and Gulf Coast tick.

Tick species	Selected diseases or conditions associated with the tick
Lone star tick (Amblyomma americanum)	Ehrlichiosis, STARI, tularemia, alpha-gal syndrome, Heartland virus, Bourbon virus
Blacklegged tick (Ixodes scapularis)	Lyme disease, anaplasmosis, babesiosis, Powassan virus
American dog tick (Dermacentor variabilis)	Rocky Mountain spotted fever, tularemia
Gulf Coast tick (Amblyomma maculatum)	Rickettsia parkeri rickettsiosis

The lone star tick deserves particular attention in the South. Public health messaging has historically focused on blacklegged ticks and Lyme disease, but lone star ticks are aggressive human biters and are associated with several bacterial, viral, and allergic conditions. [3]

Lone star ticks are also expanding their range, likely influenced by milder winters, changing land use, suburbanization, forest fragmentation, and abundant white-tailed deer populations. [3]

For more information on one important lone star tick-associated infection, see ehrlichiosis.

Why are tick populations increasing?

Tick populations and tick encounters have increased in many parts of the United States. Several factors may be contributing, including warmer temperatures, milder winters, expanding deer populations, land-use change, forest fragmentation, suburban development, and increased human activity in tick habitat.

In the southeastern United States, environmental modeling suggests that temperature, land cover, elevation, soil organic matter, vegetation, and moisture-related variables influence where different tick species are likely to be encountered. [1]

This means tick risk is not static. Areas that were once considered lower risk may change over time as ticks expand into new habitats and human exposure increases.

Are ticks active year-round in the South?

Yes. Some southern ticks remain active during the winter months. A 10-year study of tick biting in Mississippi found that the majority of tick bites by blacklegged ticks occurred in February. [4]

In an effort to identify the types of ticks biting Mississippi residents, researchers collected 119 ticks from 73 people over a 10-year period. They identified seven tick species and found that the lone star tick was the most common species biting individuals in Mississippi, accounting for 52.9% of reported tick bites. The Gulf Coast tick was the second most common, followed by the American dog tick and the blacklegged tick. [4]

These findings reinforce the need for year-round tick prevention in parts of the South.

Borrelia burgdorferi in southern animals and ticks

Researchers have identified Borrelia burgdorferi spirochetes in birds, rodents, and ticks in southern and western states. Borrelia burgdorferi has also been detected by molecular methods in wild lizards in Florida, South Carolina, and Maryland. [5]

Entomologist Dr. Kerry Clark from the University of North Florida in Jacksonville had been collecting and studying ticks his entire career before he found out personally the dangers they pose. In 2010, he became suddenly ill after dragging for ticks in Georgia.

Clark began suffering from intermittent pounding headaches, fatigue, odd twitches, and “fuzziness,” according to Discover Magazine. He tested positive for “traces of B. burgdorferi along with another distinct genospecies,” Borrelia andersonii, usually found in rabbits. Weeks-long courses of antibiotics reportedly made him feel better, but his symptoms returned when he stopped treatment. [6]

In 2013, Clark and colleagues published Lyme Borreliosis in Human Patients in Florida and Georgia, USA. The study documented PCR and DNA sequence evidence of infection with Lyme Borrelia in patients from the southern United States. The report also suggested that several Borrelia burgdorferi sensu lato species may be associated with Lyme disease-like signs and symptoms in southern states. [5]

Lizards infected with Borrelia burgdorferi?

Researchers have also investigated whether reptiles may contribute to maintaining Lyme Borrelia in southern ecosystems.

A study examining several species of lizards captured from national forests and state parks in northern and central Florida and southeastern South Carolina found evidence of infection with Borrelia burgdorferi sensu lato. PCR testing revealed 53.8% of the lizards to be positive for Borrelia burgdorferi sensu lato, including lizards from nine species and nine sites in Florida and South Carolina. [7]

Lizards in the Southeast are naturally infected with Lyme Borrelia, the authors reported, and may play a role in the enzootic maintenance of Borrelia burgdorferi sensu lato in that region. [7]

The authors cautioned, however, that “It remains to be conclusively shown whether the strains infecting lizards in the southeastern United States are cultivable in BSK medium and infectious or pathogenic to humans.” [7]

Clinical Perspective

Patients and travelers may assume that Lyme disease is only a concern in the Northeast. That assumption can lead to missed or delayed diagnosis when symptoms develop after a tick bite or outdoor exposure in the South.

At the same time, clinicians should not focus only on Lyme disease. In the Southern United States, symptoms after a tick bite may reflect Lyme disease, ehrlichiosis, Rocky Mountain spotted fever, anaplasmosis, babesiosis, STARI, alpha-gal syndrome, or another tick-borne condition.

For related diagnostic issues, see what to do after a tick bite and Rocky Mountain spotted fever symptoms.

Frequently Asked Questions

Can you get Lyme disease in the Southern United States?

Yes. Lyme disease is less common in much of the South than in the Northeast, but it can occur in southern states. Lyme disease risk has expanded in parts of Virginia, North Carolina, and neighboring Appalachian regions.

Are there ticks in the South?

Yes. Several human-biting ticks live in the South, including the lone star tick, blacklegged tick, American dog tick, and Gulf Coast tick. These ticks may transmit or be associated with multiple human diseases.

Are ticks active year-round in the South?

Yes. Blacklegged ticks may be active in autumn and winter in parts of the South. A Mississippi study found that many blacklegged tick bites occurred in February.

Does the lone star tick carry Lyme disease?

The lone star tick is not considered an important vector of Lyme disease. However, it is associated with other conditions, including ehrlichiosis, STARI, tularemia, alpha-gal syndrome, Heartland virus, and Bourbon virus.

Why are tick populations increasing in the South?

Tick populations may be increasing because of several overlapping factors, including milder winters, changing land use, forest fragmentation, suburban development, expanding deer populations, and climate-related changes in tick habitat.

Clinical Takeaway

Lyme disease can occur in the Southern United States, even though it remains more common in the Northeast and upper Midwest. Southern tick risk also includes many non-Lyme tick-borne diseases, particularly those associated with lone star ticks, American dog ticks, Gulf Coast ticks, and blacklegged ticks.

Patients and clinicians should not dismiss a tick bite, rash, fever, neurologic symptom, or unexplained illness simply because exposure occurred in the South.

Related Articles

These related articles may help readers understand southern tick risks, rashes, and related tick-borne infections.

Ehrlichiosis
Alpha-gal syndrome
STARI vs. Lyme disease
Tick bite rash

References

1. Butler RA, Papeş M, Vogt JT, Paulsen DJ, Crowe C, Trout Fryxell RT. Human risk to tick encounters in the southeastern United States estimated with spatial distribution modeling. PLoS Negl Trop Dis. 2024;18(2):e0011919.
2. Lantos PM, Nigrovic LE, Auwaerter PG, et al. Geographic Expansion of Lyme Disease in the Southeastern United States, 2000–2014. Open Forum Infect Dis. 2015;2(4):ofv143.
3. Kennedy AC, Marshall E. Lone Star Ticks (Amblyomma americanum): An Emerging Threat in Delaware. Dela J Public Health. 2021;7(1):66-71.
4. Goddard J. A 10-year study of tick biting in Mississippi. J Agromedicine. 2002;8(2).
5. Clark KL, Leydet B, Hartman S. Lyme Borreliosis in Human Patients in Florida and Georgia, USA. Int J Med Sci. 2013;10(7):915-931.
6. Discover Magazine. The Confounding Debate Over Lyme Disease in the South. December 2013.
7. Clark K, Hendricks A, Burge D. Molecular Identification and Analysis of Borrelia burgdorferi Sensu Lato in Lizards in the Southeastern United States. Appl Environ Microbiol. 2005;71(5):2616-2625.
8. Entomological Society of America. Position Paper on Tick-Borne Diseases. 2015.

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Dr. Daniel Cameron, MD, MPH
Lyme disease clinician with over 30 years of experience and past president of ILADS.

Symptoms • Testing • Coinfections • Recovery • Pediatric • Prevention