Which medicines should be taken after a tick bite?

Immediate Actions After a Tick Bite

Proper Tick Removal Techniques

Tools for Safe Removal

Proper extraction of a tick minimizes pathogen transmission and prepares the site for any subsequent pharmacological intervention. The following instruments are recommended for safe removal:

Fine‑tipped, straight‑pointed tweezers (metal or stainless steel)
Tick‑specific removal device (plastic hook or slide)
Disposable nitrile gloves
Antiseptic wipes or alcohol swabs
Magnifying glass (optional, for visual confirmation)

The procedure begins with gloves to prevent direct contact. Grasp the tick as close to the skin as possible using the tweezers or removal device, keeping the mouthparts parallel to the skin surface. Apply steady, upward pressure without twisting; the tick should detach in one motion. Inspect the bite area with a magnifier to ensure no remnants remain. Clean the wound with an antiseptic wipe, then discard all tools in a sealed container.

After extraction, evaluate the need for medication based on the tick species, attachment duration, and local disease prevalence. Prompt administration of prophylactic antibiotics or other prescribed drugs may be indicated, but only after the removal process is completed and the wound is properly disinfected.

Step-by-Step Guide

A tick bite requires prompt assessment and appropriate medication to prevent infection and complications. Follow these steps precisely.

Remove the tick – grasp the mouthparts with fine‑point tweezers, pull upward with steady pressure, and clean the area with antiseptic.
Assess the bite site – note the attachment time, if known, and look for signs of rash, redness, or swelling.
Administer a single dose of doxycycline – 200 mg orally for adults, 4.4 mg/kg for children over 8 years, within 72 hours of removal. This regimen prevents Lyme disease and other tick‑borne bacterial infections.
Consider alternative antibiotics – if doxycycline is contraindicated (pregnancy, allergy, age under 8), prescribe amoxicillin 500 mg three times daily for 14 days, or azithromycin 500 mg on day 1 followed by 250 mg daily for 4 days.
Provide analgesic and anti‑inflammatory support – ibuprofen 400 mg every 6–8 hours as needed for pain and swelling, not exceeding 1200 mg per day.
Monitor for early symptoms – educate the patient to watch for flu‑like illness, expanding rash, joint pain, or fever within 30 days.
Schedule a follow‑up – arrange a visit 2 weeks after treatment to evaluate resolution and adjust therapy if symptoms persist.

Adherence to this protocol minimizes the risk of Lyme disease, ehrlichiosis, anaplasmosis, and other tick‑borne illnesses. Immediate antibiotic therapy, combined with vigilant observation, constitutes the most effective preventive strategy.

When to Seek Medical Attention

Symptoms Requiring Urgent Care

After a tick attachment, some clinical signs indicate that delayed treatment could result in serious illness. Recognizing these signs is critical before deciding on any prophylactic or therapeutic agents.

Fever of 38 °C (100.4 °F) or higher, especially if it appears within two weeks of the bite.
Expanding rash, notably a circular lesion with central clearing (often described as a “bull’s‑eye”).
Severe headache, neck stiffness, or photophobia.
Muscle or joint pain that intensifies rapidly.
Neurological deficits such as facial droop, weakness, or tingling in limbs.
Persistent vomiting, abdominal pain, or diarrhea.
Unexplained fatigue accompanied by confusion or altered mental status.

These manifestations require immediate medical evaluation. Prompt diagnosis and appropriate antimicrobial therapy can prevent progression to Lyme disease, anaplasmosis, babesiosis, or other tick‑borne infections. Delay increases the risk of organ involvement and long‑term complications. If any of the listed symptoms develop, seek emergency care without hesitation.

Factors Increasing Risk

After a tick bite, the decision to administer medication hinges on several risk‑enhancing variables. These variables determine the likelihood of infection and guide preventive therapy.

Length of attachment: bites lasting more than 24 hours markedly raise infection probability.
Tick species: Ixodes scapularis and Ixodes ricinus are primary vectors for Borrelia burgdorferi and other pathogens; identification of these species increases risk.
Geographic prevalence: regions with documented high rates of Lyme disease or tick‑borne encephalitis demand more aggressive prophylaxis.
Host factors: immunocompromised individuals, children under eight, and pregnant women face higher complication rates.
Prior exposure: history of previous Lyme disease or co‑infection with Anaplasma, Babesia, or Rickettsia intensifies concern.
Clinical signs: emergence of erythema migrans, fever, headache, or joint pain within days of the bite signals imminent infection.

Additional considerations include seasonal timing—ticks are most active in late spring through early autumn—and the presence of multiple bites, which cumulatively raise the chance of pathogen transmission. Evaluating these elements allows clinicians to select appropriate antimicrobial or prophylactic agents promptly.

Understanding Potential Tick-Borne Diseases

Lyme Disease

Symptoms and Stages

After a tick attachment, the clinical picture evolves through distinct phases that guide therapeutic choices.

The first phase, lasting up to 72 hours, may present with a painless bite site, mild erythema, or no visible reaction. Systemic signs are uncommon. In this early window, prophylactic antibiotics such as a single dose of doxycycline (200 mg) are recommended for individuals at high risk of Lyme disease, especially when the tick is identified as Ixodes species and the attachment time exceeds 36 hours.

The second phase, emerging 3–7 days post‑bite, often includes expanding erythema migrans, fever, chills, headache, myalgia, and fatigue. Laboratory tests may reveal elevated inflammatory markers. At this stage, a full course of doxycycline (100 mg twice daily for 10–14 days) is the preferred treatment. Alternatives include amoxicillin (500 mg three times daily) for pregnant patients or those intolerant to tetracyclines, and cefuroxime axetil (500 mg twice daily) as another option.

The third phase, occurring weeks to months later, can involve neurologic manifestations (cranial nerve palsy, meningitis), cardiac involvement (atrioventricular block), or arthritic symptoms (joint swelling, pain). Management requires extended antibiotic regimens: doxycycline or ceftriaxone administered intravenously (2 g daily) for 14–28 days, depending on severity and organ system affected.

Key symptoms to monitor throughout all phases:

Localized rash (size, expansion)
Fever ≥38 °C
Headache or neck stiffness
Joint pain or swelling
Palpitations or dizziness
Facial droop or visual changes

Prompt identification of these signs determines whether prophylaxis, early treatment, or advanced therapy is indicated, reducing the risk of chronic complications.

Diagnostic Procedures

After a tick attachment, the first step is to confirm whether infection is present before prescribing medication. Accurate diagnosis prevents unnecessary drug exposure and ensures appropriate therapy.

Visual inspection of the bite site for erythema migrans or local inflammation.
Detailed history of tick exposure, including geographic region and duration of attachment.
Serologic testing for Borrelia antibodies (IgM and IgG) when rash is absent or atypical.
Polymerase chain reaction (PCR) on blood or tissue samples to detect bacterial DNA.
Complete blood count and liver function tests to identify systemic involvement.

Interpretation of results guides drug selection. A positive serology or PCR confirms Lyme disease, indicating a course of doxycycline, amoxicillin, or cefuroxime. Negative findings, combined with a clear bite site, suggest supportive care and monitoring rather than immediate antimicrobial treatment. Elevated inflammatory markers may warrant adjunctive anti‑inflammatory agents.

Follow‑up evaluation at 2‑4 weeks determines treatment effectiveness. Persistent symptoms or new laboratory abnormalities require reassessment, possible repeat testing, and adjustment of the therapeutic regimen.

Anaplasmosis and Ehrlichiosis

Key Indicators

When evaluating a patient after a tick bite, the decision to prescribe medication hinges on several measurable factors. The most reliable indicators include the duration of attachment, species identification, geographic prevalence of pathogens, presence of erythema migrans or other skin lesions, systemic symptoms such as fever, headache, or myalgia, and the individual’s immunocompetence or pregnancy status.

Attachment time longer than 36 hours markedly increases the risk of transmission and typically warrants antimicrobial prophylaxis.
Identification of Ixodes scapularis, Ixodes ricinus, or Dermacentor species in regions endemic for Borrelia, Anaplasma, or Rickettsia signals a higher probability of infection.
Development of an expanding erythematous rash within 7–14 days confirms early Lyme disease and directs therapy toward doxycycline (100 mg twice daily for 10–21 days) or amoxicillin in children and pregnant women.
Fever, chills, or elevated inflammatory markers without rash suggest early anaplasmosis or ehrlichiosis; doxycycline remains the first‑line treatment (100 mg twice daily for 10 days).
Evidence of a spotted fever group rickettsial infection, indicated by a maculopapular rash involving palms and soles, also calls for doxycycline at the same dosage.
Contraindications such as known tetracycline allergy, severe hepatic impairment, or pregnancy require alternative agents: amoxicillin for Lyme disease, azithromycin for rickettsial infections, or chloramphenicol where appropriate.

These indicators provide a clear framework for clinicians to select the most effective pharmacologic response after a tick encounter, aligning therapy with the pathogen risk profile and patient‑specific considerations.

Testing Methods

After a tick attachment, laboratory verification determines whether antimicrobial therapy is required.

Enzyme‑linked immunosorbent assay (ELISA) detects IgM and IgG antibodies against Borrelia burgdorferi and other tick‑borne agents. Results become reliable 2–4 weeks post‑exposure; early samples may yield false‑negative outcomes.
Western‑blot (immunoblot) confirms positive ELISA findings by identifying specific protein bands. Interpretation follows established criteria for each pathogen.
Polymerase chain reaction (PCR) amplifies pathogen DNA from whole blood, skin biopsy of the bite site, or the removed tick. PCR provides rapid confirmation of active infection but may miss low‑level bacteremia.
Culture isolates live spirochetes or rickettsiae on specialized media. The method is time‑consuming and available only in reference laboratories; it serves as a definitive but rarely used diagnostic.

Timing of specimen collection influences sensitivity. Acute‑phase samples (within 7 days) favor PCR and culture, whereas convalescent‑phase samples (after 2 weeks) improve serologic detection.

Interpretation of test panels guides medication selection. Positive serology or PCR for Lyme disease typically prompts doxycycline, amoxicillin, or cefuroxime, depending on patient age and contraindications. Confirmed rickettsial infection directs therapy with doxycycline alone. Negative results, when accompanied by absent clinical signs, may justify observation without antimicrobial intervention.

Laboratory results, combined with symptom assessment, provide the evidence base for prescribing the appropriate anti‑tick‑bite medication.

Other Less Common Infections

Rocky Mountain Spotted Fever

Rocky Mountain spotted fever (RMSF) is a bacterial infection transmitted by tick bites, most commonly the American dog tick, Rocky Mountain wood tick, and brown dog tick. Prompt antimicrobial therapy is essential because disease progression can be rapid and fatal.

The first‑line drug for RMSF is doxycycline. Adults receive 100 mg orally twice daily for 7–10 days, continuing until at least 3 days after fever resolves. Children younger than 8 years are also treated with doxycycline at the same dosage; recent guidelines support its use despite historic concerns about dental staining. For patients unable to take oral medication, doxycycline can be administered intravenously at 100 mg every 12 hours.

Alternative agents include chloramphenicol (50 mg/kg per day in divided doses) and fluoroquinolones, but they are less effective and reserved for cases where doxycycline is contraindicated. Pregnant women may receive azithromycin (500 mg on day 1, then 250 mg daily) if doxycycline is unavailable, though efficacy data are limited.

Key points for clinicians:

Initiate doxycycline as soon as RMSF is suspected; delay increases mortality.
Do not wait for laboratory confirmation before starting therapy.
Adjust dosage for renal or hepatic impairment according to standard pharmacologic guidelines.
Monitor patients for rash, fever, headache, and laboratory markers of organ involvement.

Early recognition of tick exposure, combined with immediate doxycycline treatment, dramatically reduces the risk of severe complications and death from Rocky Mountain spotted fever.

Powassan Virus

Powassan virus is a rare, tick‑borne flavivirus that can cause encephalitis or meningitis. Infection occurs after a bite from an infected Ixodes species, often the same ticks that transmit Lyme disease. The virus has a short incubation period (1–5 weeks) and may present with fever, headache, vomiting, confusion, or seizures. Early recognition is critical because neurological complications can be severe and may lead to long‑term deficits or death.

There is no antiviral drug proven effective against Powassan virus. Management focuses on supportive care and prevention of secondary complications. Recommended medical actions after a tick bite suspected of carrying Powassan virus include:

Immediate removal of the tick with fine‑tipped tweezers, grasping close to the skin and pulling steadily.
Observation for symptoms for at least 30 days; seek medical evaluation if fever, neurological signs, or severe headache develop.
Hospital admission for patients with neurological manifestations to allow:
- Intravenous fluids to maintain hydration.
- Antipyretics such as acetaminophen for fever control.
- Anticonvulsants if seizures occur.
- Monitoring of respiratory function and intracranial pressure.
Consultation with infectious‑disease specialists for possible enrollment in experimental antiviral trials, although none are standard of care.

Vaccination against Powassan virus does not exist; the primary preventive measure is tick avoidance, prompt removal, and use of repellents containing DEET or permethrin. If a bite is confirmed and the patient is immunocompromised or shows early signs of infection, clinicians may consider empirical treatment for other tick‑borne illnesses (e.g., doxycycline for Lyme disease) while awaiting diagnostic results, but this does not treat Powassan virus directly.

Post-Bite Medical Evaluation and Treatment Options

Initial Medical Consultation

What to Expect During the Visit

When you arrive for a consultation after a tick attachment, the clinician will first confirm the bite’s timing, location and any symptoms such as rash, fever or joint pain. A brief medical history, including allergies, current medications and immunization status, follows. The provider then inspects the bite site, removes any residual tick parts if necessary, and evaluates the surrounding skin for signs of infection or early Lyme disease.

The discussion centers on medication choices tailored to the individual’s risk profile. Common options include:

A single dose of doxycycline (200 mg) for prophylaxis when the tick was attached for ≥ 36 hours and local infection rates exceed 20 %.
A short course of amoxicillin (500 mg three times daily for 10 days) for patients unable to take doxycycline, such as pregnant women or young children.
Alternative agents like cefuroxime or azithromycin when doxycycline is contraindicated.

If early Lyme disease is suspected, the clinician may prescribe a full treatment regimen (e.g., doxycycline 100 mg twice daily for 14–21 days) and explain dosage, duration and potential side effects. For localized skin infections, topical antibiotics or a brief oral course of cephalexin may be recommended.

The visit concludes with clear instructions for self‑monitoring: observe the bite site for expanding erythema, note any new systemic symptoms, and schedule a follow‑up within 2–3 weeks or sooner if conditions worsen. Documentation of the encounter, including prescribed medication and counseling points, is provided for reference.

Information to Provide the Doctor

When you seek medical advice after a tick exposure, present the following details clearly:

Date and exact time of the bite, or the earliest possible estimate.
Geographic location where the tick was attached (city, region, type of environment).
Species of tick, if identifiable, or description of its size, coloration, and life stage (larva, nymph, adult).
Duration the tick remained attached before removal.
Method of removal (e.g., fine‑tipped tweezers, pulling straight upward) and any remnants left in the skin.
Current symptoms: fever, headache, malaise, rash (especially erythema migrans), joint pain, neurological signs, or gastrointestinal upset.
Medications already taken: name, dose, route, and timing of any antibiotics, antihistamines, analgesics, or steroids initiated after the bite.
Known drug allergies, previous adverse reactions, and any chronic conditions that could affect treatment choices (e.g., immunosuppression, renal impairment).
Recent vaccinations, particularly tetanus or any recent prophylactic antibiotics.

Provide laboratory results promptly if available, such as serologic tests for Borrelia, PCR findings, or complete blood count abnormalities. Mention any prior episodes of tick‑borne disease and the outcomes of previous treatments.

By delivering this concise, factual information, the physician can assess the risk of infections like Lyme disease, Rocky Mountain spotted fever, or tick‑borne encephalitis and select the most appropriate therapeutic regimen without delay.

Prophylactic Antibiotics

Criteria for Prescription

After a tick attachment, clinicians must decide which pharmacologic interventions are appropriate. The decision hinges on a set of objective criteria that balance efficacy, safety, and the likelihood of disease transmission.

Key factors influencing the prescription include:

Time elapsed since bite – The probability of pathogen transfer rises sharply after 24 hours of attachment; longer exposure often justifies antimicrobial therapy.
Geographic exposure – Regions with known endemic tick‑borne infections (e.g., Lyme disease, Rocky Mountain spotted fever) dictate the choice of drug and dosage.
Patient age and weight – Dosage calculations and drug selection must accommodate pediatric and geriatric physiology, avoiding agents with contraindications in specific age groups.
Allergy history – Documented hypersensitivity to doxycycline, tetracyclines, or sulfonamides excludes those options and directs clinicians toward alternatives such as azithromycin or rifampin.
Pregnancy or lactation status – Teratogenic risk eliminates doxycycline; macrolides or β‑lactams become preferred.
Immunocompromised condition – Reduced immune defenses increase the threshold for prophylactic treatment and may require broader‑spectrum agents.
Presence of symptoms – Fever, erythema migrans, or neurological signs indicate active infection, prompting therapeutic rather than prophylactic regimens.

When these criteria converge, the recommended medication is typically doxycycline 100 mg orally once daily for 10–14 days, unless contraindicated. In cases where doxycycline is unsuitable, alternatives such as amoxicillin, azithromycin, or cefuroxime are prescribed according to the same evidence‑based parameters. Continuous monitoring for adverse reactions and treatment efficacy completes the prescribing process.

Common Antibiotics Used

After a tick attachment, clinicians often prescribe antibiotics to prevent or treat bacterial infections transmitted by the arthropod. The most frequently used agents are:

Doxycycline – 200 mg orally as a single dose for prophylaxis when the tick was attached ≥ 36 hours, the region has a high prevalence of Borrelia infection, and the bite occurred within 72 hours. For early Lyme disease, a 10‑day course of 100 mg twice daily is standard.
Amoxicillin – 500 mg three times daily for 10 days, preferred for patients who cannot take doxycycline, including children under eight and pregnant women.
Cefuroxime axetil – 500 mg twice daily for 10 days, an alternative to amoxicillin for those with penicillin allergy or intolerance.
Azithromycin – 500 mg on day 1 followed by 250 mg daily for four additional days, reserved for cases where doxycycline, amoxicillin, and cefuroxime are unsuitable.

Selection depends on patient age, pregnancy status, allergy history, and timing of the bite. Early initiation, typically within 72 hours, maximizes effectiveness in preventing Lyme disease and other tick‑borne bacterial infections.

Managing Symptoms and Monitoring

Pain Relief and Anti-inflammatory Medications

Pain and swelling after a tick bite are common immediate reactions. Over‑the‑counter analgesics and non‑steroidal anti‑inflammatory drugs (NSAIDs) reduce discomfort and limit local inflammation, but they do not address potential infection. Use these agents promptly if symptoms develop, and continue according to the recommended schedule.

Acetaminophen 500 mg–1 g every 4–6 hours, not exceeding 3 g per day.
Ibuprofen 200 mg–400 mg every 6–8 hours, maximum 1.2 g per day for short‑term use.
Naproxen 250 mg–500 mg twice daily, not exceeding 1 g per day.

Select a medication based on personal tolerance and medical history. Avoid NSAIDs if you have gastrointestinal ulcer disease, chronic kidney impairment, or are on anticoagulant therapy. If fever, expanding rash, or joint pain appears, seek professional evaluation for possible antibiotic treatment.

When to Follow Up

After a tick bite, the initial step is to administer the recommended prophylactic antibiotic, typically a single dose of doxycycline, within 72 hours of removal. Prompt treatment reduces the risk of Lyme disease and other tick‑borne infections, but it does not eliminate the need for ongoing monitoring.

A structured follow‑up plan should include:

First review (7–10 days post‑bite): Confirm completion of the prophylactic dose, assess the bite site for signs of infection, and inquire about new symptoms such as fever, headache, fatigue, or a rash resembling a bull’s‑eye.
Second review (4 weeks post‑bite): Evaluate for late‑onset manifestations, including joint pain, neurological complaints, or persistent skin changes. If symptoms are present, initiate diagnostic testing and consider extended antibiotic therapy.
Third review (3 months post‑bite): Perform a final assessment for delayed presentations, especially in high‑risk regions. Document any lingering issues and advise the patient on preventive measures for future exposures.

If at any point the patient develops erythema migrans, neurological deficits, cardiac irregularities, or unexplained systemic symptoms, immediate medical evaluation is warranted regardless of the scheduled timeline. Continuous communication with the healthcare provider ensures timely detection and treatment of complications.

Preventive Measures and Future Protection

Personal Protection Strategies

Repellents and Clothing

Repellents and appropriate clothing form the first line of defense against tick‑borne infections and complement any pharmacologic intervention required after a bite. Selecting effective repellents and wearing protective garments reduce the likelihood of pathogen transmission, thereby supporting the therapeutic regimen prescribed for post‑exposure treatment.

DEET (20‑30 % concentration) provides reliable protection for up to 6 hours on exposed skin.
Picaridin (20 % concentration) offers comparable efficacy with a milder odor and lower skin irritation risk.
IR3535 (20 % concentration) is suitable for individuals sensitive to DEET or picaridin.
Permethrin (0.5 % concentration) applied to clothing, socks, and shoes creates a residual barrier lasting several weeks; re‑treatment after washing is necessary.

Protective clothing should meet the following criteria:

Long‑sleeved shirts and full‑length trousers made of tightly woven fabric to prevent tick attachment.
Light‑colored garments to facilitate visual inspection of the skin and clothing.
Tightly sealed cuffs and pant legs, preferably with elastic or Velcro closures, to block entry points.
Pre‑treated with permethrin or a comparable insecticide for added repellency.

When a tick bite occurs, immediate removal of the arthropod is followed by the recommended antimicrobial or anti‑inflammatory medication. Maintaining repellent use and wearing treated clothing during the incubation period enhances the effectiveness of the prescribed drug, reduces the risk of secondary bites, and minimizes the chance of disease progression.

Tick Checks

Tick checks are the first line of defense after a possible tick encounter. Prompt removal reduces the risk of pathogen transmission, which directly influences the need for prophylactic medication.

Perform a tick check as soon as you return indoors and repeat the examination at 24‑hour intervals for three days. Follow these steps:

Remove clothing and inspect the entire body, concentrating on hidden areas such as scalp, behind ears, underarms, groin, and between toes.
Use a fine‑tipped tweezers to grasp the tick as close to the skin as possible, avoiding compression of the body.
Pull upward with steady, even pressure until the mouthparts detach.
Disinfect the bite site with an alcohol swab or iodine solution.
Preserve the tick in a sealed container for identification if symptoms develop later.

Document the date and location of the bite, as well as the tick’s developmental stage, because these details guide the selection of antibiotics or antiparasitic agents. If the tick remains attached for more than 36 hours, or if you notice erythema, fever, or flu‑like symptoms, initiate the appropriate medication promptly, following local health‑authority guidelines.

Environmental Controls

Yard Maintenance

Effective yard upkeep reduces the likelihood of tick encounters and therefore limits the circumstances that require medical intervention after a bite. Regular mowing shortens grass, removing the micro‑habitat where ticks wait for hosts. Trimming shrubs and clearing leaf litter eliminates humid shelters essential for tick survival. Applying acaricidal treatments to perimeter zones creates a chemical barrier that lowers tick density.

Key maintenance actions include:

Mowing to a height of 2–3 inches on a weekly basis during peak tick season.
Pruning low‑lying vegetation to increase sunlight exposure and reduce humidity.
Removing accumulated leaves, pine needles, and debris from garden beds.
Installing a mulch barrier of coarse material (e.g., wood chips) between lawn and wooded areas.
Treating borders with EPA‑registered tick control products according to label instructions.

When yard conditions are optimized, the risk of acquiring a tick bite diminishes, which in turn reduces the need for prophylactic antibiotics or antihistamines following exposure. If a bite occurs despite preventive measures, prompt consultation with a healthcare professional determines the appropriate therapeutic regimen based on the tick species, attachment duration, and local disease prevalence.

Professional Pest Control

Professional pest control services reduce tick encounters by eliminating habitats, treating vegetation, and applying acaricides. Effective site management lowers the probability of bites and subsequent infection, decreasing reliance on medical intervention.

After a confirmed tick attachment, the following pharmacological measures are recommended:

A single dose of doxycycline (200 mg) within 72 hours of removal, to prevent early Lyme disease.
If doxycycline is contraindicated, a 5‑day course of amoxicillin (500 mg three times daily) or cefuroxime axetil (500 mg twice daily).
For patients presenting with rash or systemic symptoms, a 10‑day regimen of doxycycline (100 mg twice daily) is advised.
In areas with high prevalence of tick‑borne encephalitis, a single intramuscular dose of a licensed vaccine booster may be indicated, following local guidelines.

Integrating pest control with medical guidance ensures that chemical prevention and timely treatment work together. Professionals should advise clients to seek immediate clinical evaluation after a bite, report the species when possible, and maintain regular tick‑management programs to sustain low exposure risk.