Lyme disease is notoriously difficult to diagnose, because it has similar symptoms to other disorders such as fibromyalgia, multiple sclerosis, arthritis and amyotrophic lateral sclerosis. Aside from asking about your medical history, symptoms and tick exposure, your doctor will usually order blood tests to confirm diagnosis.
How Do You Test for Lyme Disease?
Lab tests identify antibodies to Lyme-causing bacteria. Antibodies, also known as immunoglobulins, are proteins created by the immune system to identify and neutralize pathogens like bacteria and viruses.1
However, your body needs time to develop antibodies against Lyme bacteria. For this reason, regular blood tests only become accurate a few weeks after you are infected.2
The Centers for Disease Control and Prevention (CDC) recommends a two-step process to check your blood for evidence of Lyme antibodies:3
1. Enzyme immunosorbent assay (ELISA/EIA) test. Also used to check for antibodies that are linked to several infectious conditions, such as squamous cell carcinoma, syphilis, rotavirus, pernicious anemia and human immunodeficiency virus (HIV), this procedure is typically used as a screening tool before more comprehensive tests are ordered.4
If the procedure has a negative result, the CDC doesn’t recommend any further testing. Just remember that false positive ELISA tests are possible, which can be caused by cross reactions with other conditions like syphilis, Epstein Barr virus and arthritis.5
2. Immunoblot or “Western blot” test. If the ELISA test has a positive or indeterminate result, this is the next step. This looks for specific antibodies produced by the body to fight antigens that are part of Lyme-causing bacteria.
Antigens are molecules that cause the immune system to produce antibodies against it.6
The immunoblot detects two classes of antibodies, immunoglobulin M (IgM) and immunoglobulin G (IgG). Testing for IgM antibodies is more effective during the first few weeks of infection, since they are produced by the body sooner. IgG antibodies are more reliable, but it can take two to four weeks for your body to make it in detectable quantities.7
If both your ELISA and immunoblot tests turn out positive, it is virtually certain you have Lyme disease.8
Reminder: These Two Lyme Disease Tests Are Often Unreliable
The Lyme-causing spirochete also has the ability to infect your white blood cells. If these cells are infected, they cannot respond to an infection normally, so the worse your infection gets, the less likely it will show up on your blood test. These two procedures need your white blood cells to function normally in order to produce the antibodies that they measure. Therefore, they are often unreliable when it comes to diagnosing Lyme disease.
There is a lab called IGeneX that specializes in Lyme testing that can detect infection much better than standard blood tests. IGeneX is accredited by the Centers for Medicare and Medicaid Services (CMS), and they hold licensure in different states including California and New York.
They offer several tests for Lyme infection that are highly specific, checking for different bacterial strains and co-infections. They also offer a procedure that checks for bacterial DNA, which is ideal for people who are not producing antibodies to Lyme-causing bacteria.9