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Lyme Disease Test – Diagnosis & Procedure Explained

The Lyme disease test is a blood test used to diagnose Lyme borreliosis, a tick-borne infectious disease. It detects antibodies against Borrelia bacteria in the blood.

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The Lyme disease test is a blood test used to diagnose Lyme borreliosis, a tick-borne infectious disease. It detects antibodies against Borrelia bacteria in the blood.

What Is a Lyme Disease Test?

The Lyme disease test is a diagnostic procedure used to detect an infection with Borrelia bacteria (primarily Borrelia burgdorferi and related species). These bacteria are transmitted to humans through the bite of infected ticks and can cause Lyme borreliosis, a multisystem infectious disease. The test is typically performed as a blood test and analyzes whether the body has produced specific antibodies against Borrelia.

When Is the Test Performed?

A Lyme disease test is ordered by a physician when a Borrelia infection is suspected. Common reasons include:

Appearance of the characteristic expanding rash (erythema migrans) following a tick bite
Unexplained joint pain, nerve damage, or cardiac arrhythmias after possible tick exposure
Persistent symptoms such as fatigue, muscle pain, or difficulty concentrating following a tick bite
Clinical suspicion of late-stage Lyme disease manifestations (e.g., Lyme arthritis or Lyme neuroborreliosis)

How Does the Test Work?

Lyme disease diagnosis typically follows a two-tiered testing approach:

Tier 1: ELISA or CLIA (Screening Test)

The first step uses an ELISA (Enzyme-linked Immunosorbent Assay) or a comparable method (e.g., CLIA) to check whether the blood contains IgM and IgG antibodies against Borrelia. IgM antibodies appear early after infection, while IgG antibodies develop later and may indicate a chronic or advanced infection.

Tier 2: Immunoblot (Confirmatory Test)

If the ELISA result is positive or borderline, a Western blot (immunoblot) is performed as confirmation. This test is more specific and checks whether the detected antibodies are directed against Borrelia-specific proteins. Only a positive result in both tiers is considered a confirmed laboratory diagnosis of Borrelia infection.

Interpreting the Results

Test results always require clinical evaluation by a physician, because:

A positive result alone does not prove an active infection – antibodies can remain detectable for years after a resolved infection.
A negative result does not fully exclude Lyme disease, especially in the first weeks after a tick bite, as antibody production takes time (the diagnostic window period).
Cross-reactions with other infections (e.g., Epstein-Barr virus, syphilis) can lead to false-positive results.

Additional Diagnostic Methods

Beyond antibody testing, other methods may be used depending on the clinical situation:

PCR test (Polymerase Chain Reaction): Direct detection of Borrelia DNA, for example in synovial fluid when Lyme arthritis is suspected, or in skin samples. Less sensitive in blood.
Cerebrospinal fluid (CSF) analysis: When Lyme neuroborreliosis is suspected, cerebrospinal fluid is examined for Borrelia-specific antibodies produced within the nervous system.
Clinical examination: The erythema migrans rash is so characteristic that its presence alone is sufficient to establish the diagnosis – no laboratory test is needed.

Treatment After a Positive Result

Confirmed Lyme borreliosis is treated with antibiotics. Depending on the stage and manifestation of the disease, commonly used options include:

Doxycycline (oral, frequently used for early Lyme disease and neuroborreliosis)
Amoxicillin or Cefuroxime (oral, as alternatives)
Ceftriaxone (intravenous, for severe cases or neuroborreliosis)

The duration of treatment is typically 2 to 4 weeks, depending on the stage of the disease and the response to therapy.

References

Centers for Disease Control and Prevention (CDC): Lyme Disease Diagnosis and Testing. Available at: www.cdc.gov (accessed 2024).
Stanek G. et al.: Lyme borreliosis. The Lancet, 2012; 379(9814): 461–473.
Wormser G.P. et al.: The Clinical Assessment, Treatment, and Prevention of Lyme Disease, Human Granulocytic Anaplasmosis, and Babesiosis: Clinical Practice Guidelines by the Infectious Diseases Society of America. Clinical Infectious Diseases, 2006; 43(9): 1089–1134.

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