The CDC classifies Washington DC, Maryland, and Virginia as high-incidence areas for Lyme. Standard two-tier blood testing catches only 22 to 36 percent of early infections, so a negative result does not rule Lyme out when symptoms are present. Free state and county programs identify a tick's species but do not test it for disease, and broader co-infection testing is not routinely ordered.

Key Takeaways

• Washington DC, Maryland, and Virginia are all CDC high-incidence areas for Lyme. Maryland runs about 1.7 times the national rate. Virginia and DC sit below it.
• This is the worst tick season since 2017, and the DMV falls in the CDC region with the highest tick-bite ER rate in the country.
• Lyme risk rises the longer a tick feeds. In animal studies, transmission happened at every attachment time tested, including the shortest. No minimum has been established below which it cannot happen.
• Half the Babesia-positive ticks in a recent mid-Atlantic study also carried Lyme, and Lyme antibiotics have no effect on Babesia.
• Standard two-tier testing catches only 22 to 36 percent of early infections, and it cannot tell you whether treatment worked.

Is Lyme disease common in Northern Virginia and Maryland?

Yes, and it is climbing fast. Maryland's reported Lyme cases have almost tripled since 2020, and the CDC classifies Washington DC, Maryland, and Virginia as high-incidence areas. Picture Lyme country and most people name New England, but the mid-Atlantic has been in the same category for years. The places on that list account for roughly 90 percent of reported US cases.

• Maryland passed 3,000 reported cases in 2024.
• Virginia's reported cases rose almost six-fold between 2000 and 2020.

The true number is close to ten times what gets counted. The CDC estimates about 476,000 people are diagnosed and treated for Lyme each year nationally, far more than the case counts that make the news.

‍

‍

The DMV sits at the lower end of that list. Maine and Vermont run several times higher. Being on it still matters, because the CDC tracks Lyme here differently than it tracks Texas or Arizona.

Why are so many people going to the ER for tick bites in 2026?

Tick-bite ER visits are running at their highest since 2017, and the DMV sits in the region leading the country. The coverage calls it a Northeast surge, but the CDC's Northeast for this data includes Washington DC, Maryland, Virginia, and West Virginia, so those headlines have been about here all along. The CDC reported the highest weekly rates for this point in the year since 2017 in every region except the South Central states.

• Regional rates climbed all spring, from about 52 per 100,000 ER visits in March to a peak near 283 in May.
• That May peak was up from about 167 a year earlier, the region's worst in years.
• Tick activity started ramping up in February and March, earlier than usual.

Some of the rise in reported cases comes from a 2022 change in how states count Lyme, and some may reflect greater awareness. ER data track visits for tick bites rather than Lyme diagnoses, but those visits are up sharply.

Which parts of the DMV carry the most risk?

Ticks carrying Lyme now live in Rock Creek Park, which puts the middle of the District on the same list as Shenandoah. A CDC and National Park Service study documented infected nymphs in park land across the region.

• Rock Creek Park, Washington DC.
• Shenandoah, Prince William Forest Park, and Manassas National Battlefield, Virginia.
• Catoctin Mountain Park and Monocacy, Maryland.

Most exposure happens at the forest edge, not deep in the woods. Leaf litter, tall grass, and deer paths are where ticks wait. Those run through backyards across Fairfax, Montgomery, and Loudoun counties. Maryland tick monitoring from 2020 through 2024 found Lyme bacteria in roughly 5 to 20 percent of the young ticks it collected.

The nymph that transmits most Lyme cases is about the size of a poppy seed, which is why so many people never notice or recall a bite. Within Virginia, the highest reported rates are in the rural southwest rather than the northern suburbs. Exposure follows habitat, not population.

How long does a tick have to be attached to transmit Lyme?

IDSA and the CDC point to a rough window, generally 36 to 48 hours before Lyme risk climbs. ILADS holds that no minimum attachment time has ever been established for Lyme transmission risk, so no clock tells you that you are safe.

All three are working from the same animal research, which tested ticks at set intervals starting at 24 hours. Transmission happened at every interval, including the shortest. It was less frequent early, then climbed steeply by 42 and 48 hours. IDSA and the CDC use 36 hours as the point worth acting on. ILADS notes that Lyme was transmitted at the shortest duration anyone has measured (24 hours), so no study has established an attachment time below which it cannot transmit.

ILADS draws a different line from the same data. Nobody has tested an attachment time short enough to come back clean, so there is no evidence that early transmission does not happen. In other animal research, a tick that fed on one host, dropped off, and reattached to a second one passed Lyme to the second host far faster. Nothing about a tick on your skin tells you whether it had fed before.

That uncertainty is about Lyme. The other infections a tick carries run on their own clocks, set by separate research, and several transmit faster than Lyme. Getting a tick off the same day puts the odds in your favor. It does not clear you, and no clinician can promise that it does.

The clock runs differently for every pathogen a tick can carry.

• Powassan virus: transmitted in about 15 minutes in animal studies.
• Borrelia miyamotoi: infected 10 percent of animals by 24 hours, 31 percent by 48.
• Anaplasma: transmitted earlier than Lyme in the one study that tested both.
• Lyme: we know risk climbs sharply after 48 hours. We do not know when it starts.
• Babesia: usually 36 hours or more.

‍

Which co-infections are most common in DMV ticks, and what are the symptoms?

Anaplasma and Babesia both matter in DMV blacklegged ticks, but Babesia deserves special attention because doxycycline does not treat it. The tick-bite antibiotic clinics reach for, doxycycline, treats Lyme and Anaplasma but has no effect on Babesia.

Babesia is a parasite related to malaria, not a bacterium, so it needs antiparasitic treatment. Someone carrying both can finish a full course of Lyme antibiotics and stay sick, which is one of the more common ways a case gets written off as treatment failure.

Babesia arrived in this region recently and it is spreading. A 2025 study in the Journal of Medical Entomology tracked both the ticks and the human cases.

• First locally acquired human cases: Maryland in 2009, Washington DC in 2013, Virginia in 2016.
• Loudoun and Fairfax were among the reporting health districts.
• Babesia turned up in 2.7 percent of the deer ticks collected across the region.
• Half the Babesia-positive ticks also carried Lyme, 18 out of 36. One carried Lyme and Anaplasma as well.

Case counts are still small, and the authors note that babesiosis may be underrecognized as it emerges in a region where clinicians have historically encountered it less often. Each co-infection has a pattern worth knowing, shown below.

‍

‍

Bartonella appears on almost every tick-borne illness list, and US published research does not establish it as tick-transmitted. It can still cause real illness, including cognitive and mood symptoms. The known routes are cat scratches and bites, fleas, and body lice. For the fuller picture on which infections a standard panel skips, see the co-infections a standard Lyme test was never built to find.

‍

‍

Is alpha-gal syndrome a risk in the DMV?

Virginia is one of the five states with the highest alpha-gal antibody rates in the country, according to CDC data published in July 2026. Unlike the co-infections above, alpha-gal is an allergy rather than an infection, and it comes from the lone star tick, not the blacklegged tick that carries Lyme. Lone star ticks are widespread across Virginia, Maryland, and Washington DC.

A positive blood test means your immune system has reacted to alpha-gal, which is not the same as having the allergy. A diagnosis needs both a positive test and a reaction that fits the alpha-gal pattern, usually hives or stomach trouble a few hours after eating red meat. Our guide to alpha-gal syndrome symptoms goes deeper.

What prevents tick bites?

Permethrin on clothing kills ticks on contact. Repellent on skin only turns them away. Both work, at different points, which is why the CDC recommends layering what you wear, what you put on skin, and what you do when you come back inside.

Before you go out:

• Treat clothing, boots, and gear with a 0.5 percent permethrin product. It survives several washings, and it never goes on skin. Pre-treated clothing works the same way.
• On skin, use an EPA-registered repellent. Five ingredients work against ticks: DEET, picaridin, IR3535, oil of lemon eucalyptus or its synthesized form PMD, and 2-undecanone. Skip the plain essential oil sold in health stores, since only the EPA-registered version is made to a tested strength and labeled for ticks.
• Wear long sleeves and long pants, and tuck the pants into your socks so a tick climbing your shoe crosses fabric rather than skin.

While you are out:

• Walk the center of the trail. Ticks wait in leaf litter, tall grass, and brush along the edges, not in the open path.
• Check while you are still outside, not only when you get home. A tick crawling on you has not bitten you yet.

Within two hours of coming inside:

• Shower within two hours of coming inside. It washes off ticks that have not attached yet, and the CDC lists it as a standard step after time outdoors.
• Do a full-body check with a mirror. Ticks concentrate in and around the hair and ears, under the arms, in the belly button, around the waistband, between the legs, and behind the knees.
• Tumble clothes in a dryer on high heat for 10 minutes, longer if they are damp. Cold and medium settings do not kill ticks.
• Keep checking for two or three days, since young ticks are easy to miss the first time.

Around your house:

• Check pets every time they come in. They carry ticks indoors that can bite someone else later. Ask your vet about tick products, and never put a dog product on a cat.
• Mow regularly, clear leaf litter, keep the yard sunny and dry, and move woodpiles away from the house.
• Yard sprays cut tick numbers, and the CDC says plainly not to rely on spraying alone.

What should you do after a tick bite?

Remove it with fine-tipped tweezers: grasp close to the skin, pull straight up, and do not throw it away. Clean the area, then take four steps.

• Write down the date and roughly how long it was attached.
• Save the tick and have it tested. Seal it in a bag, then send it to a fee-based lab that screens for pathogens.
• Call a Lyme-literate clinician, one who specializes in tick-borne illness, rather than waiting for symptoms.
• Watch for fever, headache, fatigue, joint pain, or a spreading rash for about 30 days.

A saved tick provides context, not a diagnosis. A positive tick carries roughly five times the risk of a negative one, and a swollen, positive tick reached about one case in seven in one European study. But a positive does not confirm transmission and a negative does not clear you, so the CDC says a tick result should not drive treatment on its own.

Should you take preventive antibiotics after a tick bite?

The first step after a bite is not a pill, it is an early conversation with a Lyme-literate clinician, ideally within days. What type of prophylaxis fits depends on the tick, how long it fed, and whether you were bitten in a high-risk area. The two major guidelines read the same 2001 trial and disagree.

• IDSA, AAN, and ACR (2020): a single dose of doxycycline within 72 hours, only for a bite that meets all three of their high-risk criteria.
• ILADS (2014): recommends against the single dose, favors 20 days of doxycycline when prophylaxis is used, and says the option should be discussed with everyone bitten by a blacklegged tick. Its reasoning is that no minimum attachment time has been established for Lyme, so no attachment-time rule can reliably sort who is safe.

Acting early matters more than the debate. An untreated infection can spread from the bite site to the joints, heart, or nervous system, and a case caught in the first weeks is usually simpler to treat than one found months later. One caveat applies either way: a preventive course that does not fully clear the infection can still blunt your antibody response, which makes the standard test harder to read later.

At Indigo, we start from the full picture, the tick, your timeline, your symptoms, and your history, rather than a single rule, and we lean toward early, thorough treatment over wait-and-see when the details call for it. We cover what untreated Lyme and its co-infections can lead to separately.

Where can you get tested for Lyme in the DMV?

The best place to start is a full assessment with a Lyme-literate clinician in the DMV, not the standard panel alone. We encourage testing both the tick and yourself, because they answer two different questions.

‍

‍

‍

Testing the tick:

• Virginia's state tick survey and Fairfax County name the species for free, and both say plainly they do not test the tick for disease.
• Fee-based labs like TickReport and TickCheck screen a tick for pathogens. That is a risk assessment, not a medical result.

Testing yourself:

• Standard two-tier antibody testing is the usual first step, and it misses most early infection. It looks for your immune response, not the bacteria, and its sensitivity in the first weeks has been measured at 22 to 36 percent, because antibodies take time to build. It also cannot confirm whether treatment worked, since antibodies linger for months or years after an infection clears, which is why the CDC says there is no test of cure for Lyme.

The two questions patients most want answered, do I have this and is it gone, both sit outside what the standard panel can do.

So a negative test does not rule Lyme out, and it should not end the conversation while symptoms persist. If you were bitten here and you are unwell, see a Lyme-literate clinician, one who specializes in tick-borne illness. Which broader panels make sense depends on your symptoms, timeline, and exposure. We wrote more on what to do when your Lyme test comes back negative and what each Lyme test can and cannot detect.

Getting a straight answer in the DMV

You live in one of the highest-exposure regions in the country, and the test most likely to be run on you is least reliable in the earliest stage of infection. That gap is structural. A fifteen-minute visit and a single antibody panel cannot carry a complex tick-borne case, and patients across the DMV get stranded between what the research shows about testing limits and what a routine workup does. Nobody is acting in bad faith. The tools are narrower than the problem.

Indigo Integrative Health Clinic is a telehealth practice based in Georgetown, working with patients across the DMV on Lyme and tick-borne illness. Visits are fully virtual, so you can be treated from DC, Maryland, or Virginia without driving to our clinic. Our IV Lounge is in Georgetown for the treatments that happen in person. A complimentary Discovery Call is where every Indigo patient starts. It is a 20-minute screening call, and a team member walks through your symptom history, your past testing, and what you have already tried. You come away with a clear read on whether your case is one we can help with, and what a fuller workup would look for. It costs nothing and commits you to nothing. If there is a fit, we talk about what working together looks like. Book a free Discovery Call.

If you want to evaluate a provider first, start with finding a Lyme-literate clinician in DC, Maryland, and Virginia.