Why This Matters for Maryland Hikers
Summer in Maryland is a gift. From the wooded trails of Patapsco Valley State Park to the scenic ridgelines along the C&O Canal towpath and the meadows of Sugarloaf Mountain — just a short drive from Rockville — our state offers some of the most beautiful hiking in the Mid-Atlantic. But every summer, I see patients at my Rockville practice who got more than they bargained for on the trail: a tiny passenger that hitched a ride and left behind something serious.
Maryland consistently ranks among the top 10 states in the U.S. for Lyme disease cases. In 2023 alone, Maryland reported over 1,500 confirmed cases — and that number reflects only the cases that were diagnosed and reported. Montgomery County, where Aurora Primary Care is located, sits squarely in tick country. Lyme disease is caused by the bacterium Borrelia burgdorferi, transmitted through the bite of infected black-legged ticks (also called deer ticks). The good news: Lyme disease is very treatable, especially when caught early. The even better news: it’s largely preventable.
As your primary care physician in Rockville, I want you to enjoy every trail, park, and backyard this summer — confidently and safely. Here’s everything you need to know.
Know Your Enemy: The Black-Legged Tick
The black-legged tick (Ixodes scapularis) is the primary culprit behind Lyme disease in Maryland. These are not the large, easy-to-spot ticks you might be imagining. Adult black-legged ticks are about the size of a sesame seed. But the real danger comes from the nymph stage — the juvenile tick is roughly the size of a poppy seed and responsible for the majority of Lyme disease transmissions, precisely because it is so easy to miss.
Tick season in Maryland peaks between May and July, but ticks remain active well into November — any day when temperatures are above freezing and conditions are damp is potentially tick season. They thrive in wooded areas, tall grasses, leaf litter, and shrubby understory. The parks and green spaces around Rockville and Montgomery County — Seneca Creek State Park, Black Hill Regional Park, the trails along the Potomac — are beautiful but also prime tick habitat. Ticks do not jump or fly; instead, they climb to the tips of vegetation and wait for a host to brush past.
For a tick to transmit Lyme disease, it generally needs to be attached for 36 to 48 hours. This is why checking yourself promptly after outdoor activity is one of the single most effective things you can do.
Prevention: Before You Hit the Trail
The best tick bite is one that never happens. Before you head outdoors, take these precautions:
Dress Smart
- Wear light-colored clothing — it makes ticks easier to spot before they attach.
- Tuck your pants into your socks and your shirt into your pants. It looks a bit goofy but it works.
- Wear long sleeves and long pants when possible, especially in dense wooded areas.
Use Repellent
- Apply EPA-registered insect repellents containing DEET (20–30%), picaridin, IR3535, or oil of lemon eucalyptus to exposed skin. Follow label instructions and reapply as directed.
- Treat clothing and gear with permethrin. Permethrin is applied to fabric — not skin — and remains effective through several washes. Pre-treated clothing is also available.
- For children, avoid applying repellent to hands, eyes, or mouth. DEET is considered safe for children over 2 months of age.
Stay on the Trail
- Walk in the center of trails and avoid brushing against vegetation, tall grass, and leaf litter where ticks congregate.
- Ticks are most active on warm, humid days — be extra vigilant after recent rain or on overcast, muggy mornings.
Reduce Ticks Around Your Home
You don’t have to be on a hiking trail to encounter a tick. Many patients find ticks in their own backyard — particularly in yards with wooded borders, tall grass, or regular deer activity, which is common throughout Montgomery County. The good news is that simple landscaping changes can significantly reduce tick density around your home. The CDC recommends:
- Remove leaf litter from your yard regularly — ticks thrive in damp, decomposing leaves.
- Keep grass mowed short — ticks prefer to quest in tall grass and overgrown areas.
- Clear brush around yard edges and along fences where wooded areas meet your lawn.
- Create a 3-foot gravel or wood-chip barrier between your lawn and any wooded areas or brush — ticks are reluctant to cross dry, open barriers.
- Keep play areas, swing sets, and outdoor furniture away from trees and place them in sunny, open areas of the yard.
- Store firewood neatly and in dry areas — woodpiles attract mice and other small rodents that carry ticks.
These steps are particularly worthwhile for families with young children or pets who spend a lot of time in the yard. A little prevention at home goes a long way.
The Tick Check: Your Post-Hike Routine
After any time outdoors — whether a two-mile hike or a picnic at Seneca Creek — make the tick check a non-negotiable part of coming home:
- Shower within 2 hours of coming indoors. Studies show this significantly reduces your risk of getting Lyme disease — showering helps wash off unattached ticks and gives you an opportunity to do a thorough check.
- Check your whole body — carefully. Use a mirror for hard-to-see areas. Pay particular attention to: the scalp and hairline, behind the ears, the neck, underarms, around the waist, between the legs, behind the knees, and between the toes.
- Examine your gear and clothing. Tumble dry clothes on high heat for 10 minutes before washing — heat kills ticks effectively.
- Check your pets. Dogs and cats can bring ticks inside. Check their fur, especially around the ears and collar.
- Check your kids. Children love to run through brush and tall grass. Make the post-hike tick check a fun routine — the sooner you find one, the better.
Found a Tick? Here’s What to Do
Don’t panic — finding a tick doesn’t automatically mean you have Lyme disease. The key is to remove it promptly and correctly.
How to Remove a Tick Safely
- Use fine-tipped tweezers. Grasp the tick as close to the skin’s surface as possible.
- Pull upward with steady, even pressure. Do not twist or jerk — this can cause mouth parts to break off in the skin.
- After removal, clean the bite area with rubbing alcohol or soap and water.
- Dispose of the tick by placing it in alcohol, sealing it in a zip-lock bag, or flushing it down the toilet. Do not crush it with your fingers.
What NOT to Do
- Do not use petroleum jelly, nail polish, or heat to make the tick detach — these methods are ineffective and may cause the tick to inject more bacteria.
- Do not squeeze the tick’s body — this can force infectious material into your skin.
Do I need antibiotics?
Not automatically. The CDC recommends a single preventive dose of doxycycline only when specific criteria are met: the tick is confirmed to be a black-legged tick, it was attached for 36 hours or more, the antibiotic can be started within 72 hours of removal, and you are not pregnant. Call our Rockville office if you’re unsure — we’ll help you decide the right next step.
Recognizing Early Lyme Disease: Symptoms to Watch For
Lyme disease is most straightforward to treat when it’s caught early — in the first few weeks after a tick bite. This is the stage when most patients come in, and the stage where a short course of antibiotics leads to a full recovery in the vast majority of cases. Knowing what early Lyme disease looks like is the most important thing you can do.
- Bull’s-eye rash (erythema migrans): A red, expanding rash that appears at the site of the bite in about 70–80% of infected people, typically 3 to 30 days after the bite. It often looks like a bull’s-eye with a clear center, but doesn’t always. It is usually painless and non-itchy.
- Flu-like symptoms: Fatigue, fever, chills, muscle and joint aches, headache, and swollen lymph nodes are common early signs — even without a visible rash.
- No rash doesn’t mean no Lyme: Up to 20–30% of people with Lyme disease never develop the bull’s-eye rash. If you feel flu-like symptoms within a month of a potential tick exposure, please call us — don’t wait for a rash to appear.
The key message: if you notice any of these symptoms after spending time outdoors in Maryland, call your doctor promptly. Early Lyme disease responds very well to treatment.
When to Call Your Doctor
Please reach out to Aurora Primary Care in Rockville if any of the following apply:
- You found a tick that appeared engorged and had likely been attached for more than 36 hours
- You develop a rash at or near the site of a tick bite — even if it doesn’t look like a classic bull’s-eye
- You develop flu-like symptoms within 30 days of a hike or outdoor activity, especially if combined with a known tick exposure
- You’re simply unsure — our team is here to help you navigate it without alarm
When in doubt, call us. Early evaluation is always the right move.
The Bottom Line: Enjoy Maryland Outdoors, Tick-Smart
I want my patients to be outside this summer — hiking, gardening, playing with their kids, soaking up everything Maryland’s natural landscape has to offer. Ticks are a real risk, but an informed and prepared hiker is a protected one.
Your tick-safe summer checklist:
- Dress in light-colored, protective clothing
- Apply DEET or permethrin repellent before heading out
- Stay on trail, avoid tall grass and brush
- Keep your yard tidy — short grass, clear brush, wood-chip barriers
- Do a full-body tick check within 2 hours of returning home
- Remove any tick promptly with fine-tipped tweezers
- Call your doctor if you notice a rash, flu-like symptoms, or have any concerns after a tick bite
Aurora Primary Care is here as your partner in preventive care. If you have questions about a recent tick exposure, Lyme disease, or any tick-related concerns, give us a call at our Rockville office. That’s what we’re here for.
Wishing you a healthy, adventure-filled summer.
— Dr. Mudita Malhotra, MD
Aurora Primary Care · Rockville, MD
Frequently Asked Questions
How long does a tick need to be attached to transmit Lyme disease?
In most cases, a black-legged tick needs to be attached for at least 36 to 48 hours to transmit the bacteria that causes Lyme disease. This is why prompt tick checks after outdoor activity are so important — removing a tick quickly, before it has had time to fully feed, significantly reduces your risk. If you find a tick that appears flat and unfed, your risk of Lyme transmission from that bite is very low.
Is Maryland a high-risk state for Lyme disease?
Yes. Maryland consistently ranks among the top 10 states in the U.S. for confirmed Lyme disease cases. The black-legged tick, which carries the Lyme bacteria, is well-established throughout the state — including Montgomery County and the greater Rockville area. Wooded parks, hiking trails, and even suburban backyards with deer activity can all be tick habitat. This is why Lyme disease prevention is a relevant conversation for anyone spending time outdoors in Maryland, not just avid hikers.
What does a Lyme disease rash look like?
The classic Lyme disease rash, called erythema migrans, typically appears as a red, circular or oval rash that expands outward from the site of the tick bite. It is often described as a bull’s-eye — a red ring with a clear center — though this pattern doesn’t always appear. The rash is usually not painful or itchy and may develop anywhere from 3 to 30 days after the tick bite. Importantly, up to 20–30% of people with Lyme disease never develop a visible rash, which is why flu-like symptoms following any tick exposure should prompt a call to your doctor.
Do I need antibiotics after every tick bite?
Not automatically. The CDC recommends a single preventive dose of doxycycline only when specific criteria are met: the tick is confirmed to be a black-legged tick, it was attached for 36 hours or more, the antibiotic can be started within 72 hours of removing the tick, and you are not pregnant. If you’re unsure whether those conditions apply, call your primary care provider rather than waiting. At Aurora Primary Care in Rockville, we’re happy to evaluate tick exposures and help you decide the right course of action.
When should I go to the doctor after a tick bite?
Contact your doctor if you found a tick that appeared engorged or had been attached for more than 36 hours; if you develop a rash at or near the bite site; or if you experience flu-like symptoms — fatigue, fever, muscle aches, or headache — within 30 days of a tick bite or outdoor exposure. Lyme disease is highly treatable when caught early, so acting quickly when symptoms appear matters. If you’re in the Rockville or Montgomery County area, don’t hesitate to call Aurora Primary Care.
Can my pet bring ticks into the house?
Yes. Dogs and cats that spend time outdoors are common carriers of ticks into the home. A tick that hitches a ride on your pet can detach and find a human host without anyone realizing it. Make a habit of checking your pets after outdoor activity — especially around the ears, collar area, between the toes, and under the tail. Talk to your veterinarian about tick prevention products for your pet, which protects both your animal and your family.