Written by Dr. Diane Mueller
Understanding which Lyme Disease test to use is a big and important question. To get help with Lyme testing and treatment, visit our home page HERE.
Firstly, the conventional standards are to use a test called the Elisa test as the first line of testing. Follow-up testing beyond the Elisa test is only done if the Elisa test is positive. Follow-up testing if the Elisa test is positive is meant to confirm the presence of Lyme and is done with a Western Blot test. The problem with this sort of methodology is that the Elisa test has up to a 66% chance of a false negative. This means that 66% of the time people will be positive for Lyme, but the test will report negative. And yet this is the gold standard if you want a Lyme Disease test.
The second problem is that even if you make it through the first round of testing with a positive Elisa, then the confirmatory Western Blot is needed. (to learn more about the western blot Lyme test see our blog). Western Blot is a complicated test to interpret, and many do not have the training to interpret it correctly. So, this is another area where people are told they are normal when they have Lyme Disease.
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 that 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).
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.
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.
We have other blogs on the topic of Lyme Testing that may be helpful for you.
Consider reading the following pieces of information to support you:
If you suspect Lyme Disease, the sooner you get tested the better. Since this microorganism loves to spread and disseminate throughout the body, the sooner you can address it, the better chance you have at stopping its spread and preventing it from leading to other chronic long-term health problems. Visit our home page for more information HERE.
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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