Summertime means enjoying the great outdoors: camping, picnics, boating and relaxing in a hammock under your favorite shade tree. Life is good. Then, there’s the itching, stinging, swelling and scratching. Bug bites are bad.

Most insect bites are not dangerous, but they can be itchy and irritating, and a few are gateways to serious insect-borne diseases. If you spend much time outside, you’re bound to be bitten before the first frosts drive the insects away.

The two types of bites that seem to cause the most alarm come from ticks and mosquitoes. Both can be disease vectors, and this season has no shortage of either pest. Martha Baur, co-owner of Mosquito Squad, says they’re busier than ever repelling mosquitoes, ticks and fleas.

“In the last two seasons, I had maybe five calls about ticks by the end of June. This year, I’ve had almost 50,” Baur says. “People have found ticks on their dogs or children. One lady called from Clayton because her dog contracted rocky mountain spotted fever from a tick. The vet was shocked because it’s such an urban area.”

Characterized by severe, flu-like symptoms, muscle pain, and a red, spotted rash that appears a few days later, rocky mountain spotted fever is one of the most well-known tick-borne diseases. “The name is a misnomer,” says Dr. Jason Hand of Mercy Clinic Internal Medicine Des Peres. “The two most common geographic locations for this infection are North Carolina and the Missouri/Arkansas/Oklahoma area.”

Lyme disease is a more notorious tickborne illness that causes fever, headaches, fatigue, and a ‘bull’s eye’ skin rash. Early diagnosis and treatment are important in order to avoid permanent damage to the joints, nervous system and heart. “The infection everyone fears is Lyme disease, but this infection is very rare in Missouri,” Hand says. According to the U.S. Centers for Disease Control and Prevention, there were only four confirmed cases of Lyme disease in Missouri during 2010.

“A much more common infection in Missouri is very similar to Lyme disease, and that is ehrlichiosis,” Hand says. “It can be a quite serious infection, and in my six years of practice I’ve seen at least 10 cases of people having to be admitted to the hospital for this infection.” Symptoms begin at least five days after infection and include fever, chills, headache, muscle pain, nausea and fatigue.

Mosquitoes pose different problems and tend to spread disease later in the summer, says Dr. James Hinrichs, an infectious diseases specialist and chief medical officer for SSM St. Joseph Health Center. West Nile virus often has no noticeable symptoms, but can lead to encephalitis, a dangerous brain infection.

“If you’ve been exposed to West Nile, the mosquito bite won’t feel any different than if it were a regular bite,” Hinrichs says. “The importance there is to try to avoid the bite completely. Obviously, any bite if it’s scratched and gets irritated can lead to a secondary bacterial infection. We all carry staph in our skin and sometimes strep, so you want to keep it clean. Hygiene has a lot to do with keeping secondary infections from developing.”

Hinrichs notes that West Nile virus cases have dropped off in the last few years. “When it came through (in the early to mid-2000s), I saw several patients die of West Nile, and it’s somewhat of a mystery as to why it hasn’t come back,” he says. The Missouri Department of Health and Senior Services reported less than a dozen confirmed cases in 2011.

Because the disease is passed between birds and mosquitoes, the infected bird population was decimated, but the bird population may be rebounding, Hinrichs notes. “Every year, there’s always that worry that West Nile might come back again,” he says. Older people are at greater risk of developing encephalitis from West Nile virus, and there are no known vaccines or treatments for humans.

Despite the risk of disease, don’t panic if you get a bug bite. A fever or rash associated with a recent insect bite should be checked out by a physician. Topical steroids and antihistamines can help control itching, and that’s the worst problem most people have as a result of those annoying summer pests.