Almost all of these are trivial. The few that are not divide into three groups: bites that get infected, bites that transmit something, and stings that cause anaphylaxis — and each needs a different thing from you.
Anaphylaxis first, always. Any bite or sting followed by swelling beyond
the site, a change in voice, difficulty breathing, or feeling faint is anaphylaxis
until proven otherwise — adrenaline, lie flat, 999. A sting in the mouth or throat can also
obstruct an airway mechanically, without any allergy at all, and needs the same urgency.
1. Insect stings
- Get the sting out sideways. Scrape it off with a fingernail or a card edge rather than gripping it — squeezing the attached venom sac injects the rest. Only bees leave one; wasps do not.
- Then cold, and time. An ice pack and elevation. Redness, swelling and itching lasting up to about ten days are normal and are not infection.
- A large local reaction is not an allergy. A whole forearm swelling after a sting on the hand is unpleasant, common, and not a predictor of anaphylaxis next time. What predicts that is a reaction away from the site.
- Antihistamines help the itch, and antibiotics do not help a sting. Infection after a sting is uncommon and looks different: worsening after day two, spreading redness, heat and pain rather than itch.
2. Ticks — the short version
Remove it now, mechanically, and correctly. Fine-tipped tweezers or a
tick-removal tool, gripping as close to the skin as you can, pulled straight up with steady even
pressure. No jerking, no twisting. Then soap and water.
And nothing else touches it — no burning, petroleum jelly, butter, alcohol or nail varnish. All are folk remedies and all risk making the tick regurgitate into the wound. Transmission rises with attachment time, so speed and technique are the whole intervention.
- Note the date and the body site. If something appears six weeks later, that is the most useful information anyone will have.
- Watch for an expanding rash for a month. Erythema migrans appears 3 to 30 days later, grows beyond about 5 cm, and is usually not a bullseye — waiting for one is how the diagnosis gets missed. It is a reason to be treated, not tested.
- Antibiotic prophylaxis is not routine in the UK, which differs from American practice and is why people ask for it.
Tick bites and tick-borne disease — in full covers the NICE treatment table, testing and when it misleads, the reasoning behind the UK prophylaxis position, prevention, persistent symptoms after treated Lyme disease, and tick-borne encephalitis, which is now established in a few parts of Britain.
3. Animal and human bites
| Do | Do not |
|---|---|
| Irrigate immediately and generously under running water — the volume is the treatment, exactly as in wounds. Encourage a little bleeding from a puncture. Cover, elevate, and get it assessed | Close it. Bites are usually left open deliberately, because stitching seals bacteria into a deep space. Do not glue or steri-strip a bite |
- Human bites carry the highest infection risk of the common ones, and the one that matters most is barely recognised as a bite: a knuckle wound from punching someone in the mouth. Small, unimpressive, and over a joint that inoculates directly into the tendon sheath. It is a hand-surgery problem until proven otherwise and must be seen the same day.
- Cat bites look trivial and behave badly — needle-sharp teeth deposit bacteria deep and the skin closes over it. Low threshold for assessment.
- Dog bites do more crush and tearing damage but seal less. Still assess, particularly on the hand or face.
- Antibiotics are not automatic. If the skin is not broken, they are not indicated at all. Beyond that it depends on the species, the site and the person, which is a clinician's judgement rather than a rule.
- Check tetanus for any puncture or contaminated bite.
- Rabies: no indigenous infection in UK animals — with one exception. Bats. Any bat bite, scratch or mucous membrane contact, in the UK or anywhere, needs urgent assessment for post-exposure treatment. Abroad, any bite or scratch from a mammal is a same-day medical problem, and this is the single most important thing to know before travelling with children. Monkey bites carry their own risk and need specialist advice.
4. British wildlife people worry about
| What to do | |
|---|---|
| Adder | The only venomous snake native to Britain, and bites are very rarely fatal — but they can cause marked swelling and systemic illness, and there is an antivenom. Keep them still, immobilise the limb at heart level or lower, remove rings and watches before swelling starts, and get them to hospital. No tourniquet. No cutting. No sucking. No ice. All four are folk remedies and all four cause additional harm. Note the time, and mark the edge of the swelling with a pen and the time beside it — the rate of spread is what the hospital wants and it cannot be reconstructed later. Photograph the snake only if it is safe and instant; identification is not worth a second bite. Bites can be “dry” with no venom at all, which is common — but that is a hospital determination after a period of observation, not a reason to stay at home |
| Weever fish | Trodden on in shallow water on sandy beaches; spines on the back cause disproportionate pain. Immerse the foot in water as hot as can be tolerated without scalding, for 30 to 90 minutes — the venom is heat-labile and this genuinely works. Check for and remove any spine fragments. The heat is the treatment, so top the water up as it cools — the pain returning is usually the water dropping below effective temperature rather than the venom persisting. Test it on your own hand first, because the injured foot judges temperature poorly and scalds are a real complication of this |
| Jellyfish and Portuguese man o' war | Rinse with seawater, not fresh water — fresh water makes remaining stinging cells fire. Lift tentacles off with tweezers or a card edge, do not rub or use sand, then hot water or a cold pack for pain. Vinegar is for tropical box jellyfish and is not recommended for UK species, where it can make some worse |
| Horsefly | They cut rather than pierce, so the bites are slow to heal and infect more often than most. Clean it properly and watch it |
| Spiders | No UK spider causes medically significant envenomation. False widow bites hurt and occasionally get infected; that is the extent of it |
When a bite or sting becomes a medical problem. Spreading redness or a red
line tracking up the limb, worsening pain after day two, pus, fever, a bite over a joint or on the
hand or face, any bite that will not stop bleeding, any deep puncture, any bat contact, anything
abroad, and any reaction beyond the site. Everything else is cold, time and patience.