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Lyme Disease Blood Test – Diagnosis & Process

A Lyme disease blood test detects antibodies against Borrelia bacteria in the blood. It is used after a tick bite or when typical symptoms of Lyme disease are present.

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A Lyme disease blood test detects antibodies against Borrelia bacteria in the blood. It is used after a tick bite or when typical symptoms of Lyme disease are present.

What is a Lyme Disease Blood Test?

A Lyme disease blood test is a diagnostic procedure used to detect an infection caused by Borrelia burgdorferi, the bacteria responsible for Lyme disease (also called Lyme borreliosis). Lyme disease is primarily transmitted through the bite of infected ticks and is one of the most common tick-borne illnesses in Europe and North America.

Rather than detecting the bacteria directly, the blood test measures antibodies produced by the immune system in response to a Borrelia infection. Since these antibodies take several weeks to reach detectable levels, the timing of the test plays a critical role in the accuracy of the results.

How Does the Lyme Disease Blood Test Work?

Laboratory diagnosis of Lyme disease typically follows a two-tier testing approach:

Tier 1 – Screening Test (ELISA): An ELISA (Enzyme-Linked Immunosorbent Assay) is performed first. This test checks for the presence of IgM antibodies (indicating early infection) and IgG antibodies (indicating later or past infection) against Borrelia. A positive or borderline result requires confirmation.
Tier 2 – Confirmatory Test (Western Blot / Immunoblot): If the ELISA result is positive or equivocal, a Western blot (also called immunoblot) is performed. This more specific test identifies antibodies against individual Borrelia proteins. A diagnosis is confirmed only when both tests yield positive results.

When is the Test Recommended?

A Lyme disease blood test is typically recommended in the following situations:

After a tick bite, especially if the tick was attached for more than 24 hours
When a bull's-eye rash (erythema migrans) appears – the characteristic circular skin rash associated with early Lyme disease
When unexplained symptoms occur, such as persistent fatigue, joint or muscle pain, neurological complaints, or cardiac irregularities
To rule out Lyme disease as part of a differential diagnosis

What Does the Test Measure?

The blood test measures IgM and IgG antibodies against Borrelia bacteria:

IgM antibodies develop within the first few weeks of infection and are indicative of an early or acute Lyme disease infection.
IgG antibodies develop later and may remain detectable for months to years after infection – even following successful antibiotic treatment.

It is important to note that a positive test result does not automatically indicate an active infection. Antibodies may persist long after the infection has resolved. Test results must always be interpreted in the context of clinical symptoms and the patient's medical history.

Limitations of the Test

The Lyme disease blood test has several important limitations that must be considered when interpreting results:

Diagnostic window period: During the first 2 to 4 weeks after infection, antibodies may not yet be detectable. A negative test does not rule out early Lyme disease.
False-positive results: Other infections (e.g., Epstein-Barr virus, syphilis) or autoimmune conditions can produce false-positive results.
False-negative results: Early antibiotic treatment can suppress antibody production, potentially leading to false-negative results.
No marker of active disease: The test cannot distinguish between an active infection and a previously resolved one.

Diagnosis and Clinical Relevance

The diagnosis of Lyme disease is never based on blood test results alone. Physicians always consider a combination of:

Clinical symptoms (e.g., bull's-eye rash, joint swelling, neurological signs)
Laboratory findings (two-tier antibody testing)
Medical history (recent tick bite, exposure to tick-endemic areas)

In certain cases – such as suspected neuroborreliosis – analysis of the cerebrospinal fluid (CSF) may also be required for a definitive diagnosis.

Treatment Following a Positive Result

When Lyme disease is confirmed, antibiotic therapy is initiated. Commonly used antibiotics include doxycycline, amoxicillin, or ceftriaxone, depending on the stage of the disease and the organ systems affected. Treatment typically lasts 2 to 4 weeks. When diagnosed and treated early, the prognosis for Lyme disease is generally excellent.

References

Robert Koch Institute (RKI): Lyme Borreliosis – Information for Healthcare Professionals. Available at: https://www.rki.de
Stanek G. et al.: Lyme borreliosis. The Lancet, 2012; 379(9814): 461–473. Available at: https://www.thelancet.com
Centers for Disease Control and Prevention (CDC): Lyme Disease – Testing. Available at: https://www.cdc.gov/lyme

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