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Southern Tick-Associated Rash Illness (STARI)

Southern tick-associated rash illness (STARI) is a Lyme disease-like illness that produces an expanding circular skin rash (erythema migrans) at the site of attachment from the lone star tick within approximately seven days. Lone star ticks are commonly found in Oklahoma and are known to aggressively bite humans. It has been described in patients in the southeastern and south-central states, including Oklahoma. This illness is indistinguishable from the early stages of Lyme disease.  The rash may be accompanied by a mild illness characterized by fever, generalized fatigue, headache, muscle, and joint pain. STARI is not listed specifically as a reportable disease/condition, but it is uncommon and should be reported to Infectious Disease Prevention and Response within one business day.   

An etiologic agent has not yet been definitively identified; therefore, there are no commercial laboratory tests to test patients for this illness.  It is still unclear as to whether antibiotic treatment is necessary or beneficial for patients diagnosed with STARI. Nevertheless, physicians often treat patients with oral antibiotics as the illness so closely resembles Lyme disease. Contact your physician if you think you might have STARI, or any symptoms of illness that develop within two weeks of tick exposure. Prevention measures for STARI are like other tickborne diseases: avoid tick-infested areas, frequently check to identify and remove ticks properly, and use tick repellant when indicated.

All persons are susceptible to STARI, but persons who spend long amounts of time outdoors are more likely to be bitten by infected ticks. Personal tick bite prevention precautions should be taken before undergoing summer activities, especially during the spring and summer months.

Southern Tick-Associated Rash Illness is not a reportable disease in Oklahoma. 

The best way to protect yourself from STARI and other tickborne diseases is to prevent tick bites. Personal tick bite prevention precautions include: 

  • Wear light colored clothing to make ticks easier to see. 
  • Wear long-sleeved shirts and long pants tucked into sock to deprive ticks of attachment sites. 
  • Wear closed-toe shoes, not sandals. 
  • Hikers and bikers should stay in the center of trails to avoid grass and brush. 
  • Check for ticks AT LEAST once per day; particularly, along waistbands, in the armpits, and groin area. Don’t forget the back and the hair! 
  • Use a tick repellant with DEET on skin and clothing according to the directions. 
  • Use a tick repellant with permethrin ON CLOTHING ONLY as directed by the label.

The symptoms of STARI are like the early symptoms of Lyme disease. A large bull’s-eye shaped rash and mild symptoms of fever, tiredness, headache, and muscle/joint pains have been reported. You may or may not recall being bitten by a tick in the previous two to three weeks prior to symptom onset date.

Since the cause of STARI is still considered unknown, no commercial lab tests have been developed to detect infection in humans. Therefore, diagnosis is generally based on symptoms (including rash), as well as a patient’s geographic location in the United States. It is still unknown whether antibiotic treatment is beneficial for those who are diagnosed with STARI, but your physician may prescribe antibiotics to treat STARI. You do not need to take antibiotics just because a tick bites you. Most tick bites will not result in STARI, or other diseases transmitted by ticks.