Practice Guideline

. 2020 May;42(5):644-653.

doi: 10.1016/j.jogc.2020.01.001.

Committee Opinion No. 399: Management of Tick Bites and Lyme Disease During Pregnancy


Objective: Lyme disease is an emerging infection in Canada caused by the bacterium belonging to the Borrelia burgdorferi sensu lato species complex, which is transmitted via the bite of an infected blacklegged tick. Populations of blacklegged ticks continue to expand and are now established in different regions in Canada. It usually takes more than 24 hours of tick attachment to transfer B. burgdorferi to a human. The diagnosis of early localized Lyme disease is made by clinical assessment, as laboratory tests are not reliable at this stage. Most patients with early localized Lyme disease will present with a skin lesion (i.e., erythema migrans) expanding from the tick bite site and/or non-specific “influenza-like” symptoms (e.g., arthralgia, myalgia, and fever). Signs and symptoms may occur from between 3 and 30 days following the tick bite. The care of pregnant patients with a tick bite or suspected Lyme disease should be managed similarly to non-pregnant adults, including the consideration of antibiotics for prophylaxis and treatment. The primary objective of this committee opinion is to inform practitioners about Lyme disease and provide an approach to managing the care of pregnant women who may have been infected via a blacklegged tick bite.



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A few points:

  • I’m glad they acknowledge that ticks are expanding everywhere – and that goes for ALL ticks.
  • In my opinion, as these ticks expand, biting animals/people outside of their typical range, more transmission studies need to be done to determine if they are also picking up new pathogens not common to them previously.  This would help explain the expansion of pathogens as well as ticks. Unfortunately, researchers are content with 35+ year old studies with an inch of dust on them.
  • It DOES NOT take 24 hours to become infected and a minimum time has never been established:
  • I’m glad they acknowledge that Lyme/MSIDS is a clinical assessment.  Unfortunately, due to top down education from the CDC/IDSA, doctors are woefully unprepared to make this assessment.  There needs to be an overhaul on this aspect of medical training and they should listen to Lyme literate doctors with decades of experience rather than vilify them:
  • Most patients will NOT present with a skin lesion:
  • I’m extremely grateful they recommend considering prophylactic treatment.  Unfortunately, again due to top down education from the CDC/IDSA, doctors are scared to death to use antibiotics for this, further revealing the need for education on the severe nature of this disease(s) and the potential for congenital transmission affecting the life of the newborn forever. This detail makes it clear any risk is worth the benefit, but only if you are knowledgable about the severity of the disease(s).
  • No mention of coinfections is given, and this is another important issue mainstream medicine is clueless about. Patients that are coinfected are sicker for longer and require far more than the typical mono treatment.

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