Lyme Disease Doctor

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What are the Best Lyme Disease Tests for you?

lyme disease test

Written by Dr. Diane Mueller

Understanding which Lyme Disease test to use is a big and important question. 

As antibody-based tests like ELISA, IFA, Western blot, and Immunoblot, though they’re the most common tests, don’t directly detect the presence of the bacteria. Instead, they identify antibodies in your blood or spinal fluid, which form in response to the bacterial infection.

Table of Contents

Key Takeaways

  • Lyme disease test typically involves checking your blood for the presence of antibodies or Lyme disease bacteria DNA.

  • The test results can be a bit ambiguous, a negative result can mean that you don’t have Lyme disease or it could be a false-negative. A positive result could indicate an ongoing infection or a previous encounter with the disease.

  • Testing for Lyme disease is crucial, particularly in the later stages, due to its diverse symptoms. The test involves a simple needle prick to check for antibodies or bacterial DNA in the blood.

  • Several types of tests can be used to detect Lyme disease such as blood tests, Lyme Screen Immunoassay (LSA), Lyme Broad Coverage Ab Assay, and others. The right test for you will depend on your specific condition and symptoms.

  • Additional methods for diagnosing Lyme disease include cerebrospinal fluid tests, imaging techniques like MRI, SPECT, and PET scans, skin biopsy, EMG/nerve conduction studies, etc. These tests provide further insight into the disease’s impact on your body.

  • One of the biggest challenges in Lyme disease testing is the possibility of false positives or negatives. Existing tests have a sensitivity of only 70-90% in neurologic Lyme disease, leading to a high risk of misdiagnosis.

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The Importance of Lyme Disease Testing

Indications for Testing

You’re most likely asked to undertake a Lyme disease test when you show symptoms common to the illness. Administering this test is vital as it provides crucial information that assists clinicians in determining if Lyme disease is the correct diagnosis. A positive test result indicates a high probability of a past or recent infection from Borrelia burgdorferi. This indication may also include instances of stiff neck or numb hands or feet, which suggest the disease is impacting your nervous system.

Remember, a negative test result isn’t definitive, especially early in the infection. It typically takes the immune response about one to three weeks to form antibodies. And this is crucial. Why? The formation of antibodies is essential for the tests to function properly, which is why Lyme Disease testing is particularly applicable in the late disseminated stage of the disease.

Risks of Untested Lyme Disease

Postponing testing or disregarding Lyme disease can lead to problematic situations. By the time antibodies have risen sufficiently to be detected, Lyme disease may have advanced to more severe stages. In extreme instances, ten to twenty-year-old studies have shown, people can still test positive due to the long-term memory of the immune response.

From the above, it’s clear that Lyme disease testing is a process famed for its uncertainties. With studies indicating a sensitivity of only 70-90% in neurologic Lyme disease for current tests, there’s always a risk of a false positive or negative. And as the tests are somewhat subjective, especially the IFA, reliance on just test results can lead to misdiagnosis.

But, don’t let this discourage you. In the end, Lyme disease tests still provide valuable information on the possibility of infection, even if insufficient on their own. So, they remain an instrumental part of diagnosis, serving as a critical tool that aids healthcare professionals in making informed decisions about treatment protocols. Balance these facts, and you’ll appreciate that, fraught with challenges as it may be, Lyme Disease testing is a necessary step on the path to regaining your health.

Keep in mind at our medical clinic that most of the people we find positive for Lyme Disease testing do not even remember getting a tick bite.

Types of Lyme Disease Tests

To determine the presence or past occurrence of Lyme disease, different diagnostic tests come into play. The focus here is mainly on antibody detection. By evaluating the body’s immune response to the Borrelia bacteria which causes Lyme disease, doctors can make a more precise diagnosis.

lyme disease lab

Blood Tests

Blood tests form the first line of defense for Lyme disease detection, extensively used for initial screening. Blood samples collected are analyzed for specific antibodies that the immune system produces against the Borrelia bacteria.

Lyme IgG/IgM Antibody Serology, for instance, identifies both IgM and IgG antibodies. As the first antibody in the body’s immune response, IgM comes into focus at an early stage, while the presence of IgG antibodies indicates a late-stage infection or previous exposure to the bacteria.

The Lyme Screen Immunoassay (LSA) offers quicker results, employing an antigen to detect Lyme antibodies. This LSA is relatively new, that looks for a quicker diagnosis and treatment.

Another blood-based test, the Lyme Broad Coverage Ab Assay, detects other antibodies against Borrelia, providing comprehensive insight into your body’s immune response.

The Lyme ImmunoBlot, Lyme Western Blot, Lyme IgM, and IgG 31kDa Epitope Test, checks your body’s immune reaction and verifies the presence of Lyme disease-specific antibodies.

Tests such as the Lyme Multiplex PCR and Lyme Dot-blot Assay (LDA) identify DNA or RNA of the bacteria, providing more direct evidence of the infection. They are useful when antibody production hasn’t been initiated yet.

The Lyme IgXSpot test assesses the immune response on a cellular level, detecting significant defensive cells to implicate an active infection, while the Lyme cePCR technique detects the DNA of Lyme bacteria in your blood, providing evidence of current infection.

Other Diagnostic Methods

Other diagnostic techniques can provide a more comprehensive identification and understanding of Lyme disease. These methods investigate other aspects of your body’s response to this disease and its potential co-infections.

Cerebrospinal Fluid Tests

Apart from blood testing, your health provider may turn to cerebrospinal fluid (CSF) tests. If your symptoms indicate a possible nervous system disruption—like stiff neck or numb extremities—CSF tests may be in order.

To perform a CSF test, a procedure known as lumbar puncture is conducted. Needle insertion between two lower spine vertebrae affords a CSF sample so an anesthetic will be required.

Imaging Techniques

Magnetic Resonance Imaging (MRI), SPECT, and PET scans are imaging tools that provide insight into potential damage to your brain and nervous system.

EMG/Nerve Conduction Studies

Electromyography (EMG) and nerve conduction studies explore your muscle and nerve functioning, indicating possible nerve damage caused by Lyme disease.

Skin Biopsy

Lyme disease often manifests initially as a skin rash so a skin biopsy may be required to analyze tissue from the rash area for evidence of infection.

Neuropsychological Testing

As mentioned, Lyme can impact neurological function, so getting neuropsychological tests provides data on cognitive functions.

Interpreting Test Results

Lyme disease tests can be complicated due to the infection’s intricate nature. Lyme Disease can coexist with other infections such as Bartonella, Rocky Mountain Spotted Fever, and Babesia. It’s recommended to consult with a Lyme Literate Doctor to ensure comprehensive evaluation and accurate interpretation of test results.

Challenges in Lyme Disease Testing

False Positives and Negatives

A common challenge encountered in Lyme disease testing involves false negatives and false positives. Usually, the first step in testing employs the Elisa test, but it’s worth noting that this method carries up to a 66% chance of a false negative. It means that the Elisa test could report a negative result when, in truth, you are positive for Lyme. Shockingly, this is considered the gold standard in Lyme disease testing, even though a significant margin of error.

If by chance, your result from the Elisa test comes back positive, you’ll then go through a confirmatory Western Blot test. But the interpretation of a Western Blot test isn’t as straightforward as it could be. It’s a complex process, and your test findings could be misread if the interpreter isn’t adequately trained. So, you might be diagnosed as normal, even though having Lyme disease.

What is the Most Accurate Lyme Disease Test?

The first thing to really understand about a Lyme Disease test is that standard testing is incredibly inaccurate. The doctors who interpret it often times are uneducated in terms of Lyme Disease and therefore do not do a great job at properly identifying this disease.

There are options however! The first thing, is work with a Lyme Literate Doctor to make sure that you are properly evaluated for Lyme Disease. 

Secondly, make sure that you are working with someone who understands that Lyme Disease (which is technically an infection from the microorganism called Borrelia) often times coexists with other infections such as Bartonella, Rocky Mountain Spotted Fever and Babesia (as well as others). You will want to not only be evaluated for Lyme, but for other infections that are transmitted through insects as well. (note that we say insects because some preliminary research is showing that mosquitos and fleas may carry Lyme).

Thirdly, there is not a great test for determining if Lyme has gone away. With most infections, the body will have immune markers that elevated in acute infections (IgM) and immune markers that are signs of a remnant previous infection (IgG). With Lyme Disease, the microorganisms can go in and out of dormancy. Because of its ability to go dormant, in these cases, someone may only have the IgG (remnant) markers elevate. But, Borrelia can easily come out of dormancy (happens a lot with stress) and then the acute markers could elevate again. Therefore, treatment progress is largely based upon symptom improvement. There still needs to be more advancement in Lyme Testing in order to be able to better identify acute versus past infections.

Additional Lyme Disease Test Resources

Consider reading the following pieces of information to support you: 

  1. At-Home Lyme Disease Tests:  Learn about options for getting tested at home

  2. Lyme Disease Test Kit: Learn about the pros and cons of various testing companies out there

  3. Lyme Disease Test Years Later: If you believe that you contracted Lyme a long time ago

  4. Tests for Chronic Fatigue Syndrome: If you are feeling unusually exhausted 

  5. Fibromyalgia Symptoms in Females: Women, should you feeling fatigue, pain, or a range of other issues. 

  6. What Is Chronic Fatigue Syndrome: Find out if you have CFS vs just being tired 

  7. Lyme Disease and Brain Fog:  Read about how Lyme affects cognitive function

  8. Lyme Disease Eyes: How Lyme can affect your vision


One of the biggest take-home points is the importance of being a self-advocate when it comes to Lyme Disease testing. Remember most doctors are not well-versed in truly understanding Lyme Disease Testing. And even fewer are versed on the number of symptoms and complications that can occur from Lyme Disease.

Often times people think that if they did not have a bullseye rash and a fever they are fine, but left untreated, Lyme Disease and other tickborne infections can cause a wide variety of neurological, cognitive, cardiac, and inflammatory processes. Many people are told that everything is normal with them when they know something is wrong because, with Lyme Disease, standard tests look normal most of the time. People are often told they are crazy and that it must be in their heads because common tests fail to elicit the underlying true problem. 


Cook MJ, Puri BK. Application of Bayesian decision-making to laboratory testing for Lyme disease and comparison with testing for HIV. Int J Gen Med. 2017 Apr 10;10:113-123. doi: 10.2147/IJGM.S131909. PMID: 28435311; PMCID: PMC5391870.

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