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Lyme Disease Blood Tests

Formal name: Borrelia burgdorferi Antibodies, IgM/IgG; Borrelia burgdorferi DNA Detection by PCR

Lyme disease tests are used to determine if a person with characteristic signs and symptoms has been infected by the bacteria Borrelia burgdorferi. The tests detect antibodies produced by the immune system in response to the infection.

Lab tests can detect two different classes of antibody, IgM and IgG.

  • B. burgdorferi IgM (immunoglobulin M) antibodies are usually detectable in the blood about two to three weeks after exposure. IgM levels increase to maximum concentrations at about six weeks and then begin to decline.
  • IgG (immunoglobulin G) antibodies are not detectable until several weeks after exposure, increase to maximum levels at about four to six months, and may remain at high levels for several years. offers the following tests:

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Lyme Disease Antibody (EIA) Immunoassay
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Lyme Disease Antibodies (IgG, IgM), Western Immunoblot
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Our Price: $132.40
Immunoblot testing is appropriate for confirming a detected EIA or IFA test result.

LYME Anitibody Western Blot CONFIRMATION
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The Centers for Disease Control and Prevention (CDC) recommends that two different methods be used to detect these antibodies and to confirm a diagnosis of Lyme disease. The initial test is intended to be very sensitive so that it will detect as many cases of Lyme disease as possible. However, it may be positive when a person does not have Lyme disease but has some other condition, such as a different tick-borne disease, syphilis, or an autoimmune disorder such as lupus. Therefore, if the result of the initial test is positive, a second test that uses a different method is used to confirm the findings. The following chart illustrates the recommended steps:

Lyme disease two tiered testing by CDC

Lyme disease can sometimes be challenging to diagnose. If a person has removed a tick from his or her skin, had a known tick bite, and lives in or has visited an area of the country where Lyme disease is most prevalent, then the timing of the potential infection can be closely estimated. However, the tick is about the size of the head of a pin and the bite may not be noticed. Not everyone will develop the characteristic rash, and the symptoms that a person does have may be nonspecific and flu-like in the early stages, with joint pain that develops into chronic arthritis and/or with neurological symptoms that appear months later.

A blood test for antibodies to the bacteria is the preferred test for the diagnosis of Lyme disease. However, if a person has central nervous system symptoms, such as meningitis, then IgM, IgG, and western blot testing may sometimes be performed on cerebrospinal fluid (CSF).

In special cases, polymerase chain reaction (PCR) testing may be performed on a sample because it is a more sensitive way of detecting an infection with B. burgdorferi. However, this is not an FDA cleared or approved test method and it is not widely available. The CDC does not currently recommend PCR testing for the diagnosis of Lyme disease.

When is Lyme disease blood test ordered?

Lyme disease testing is ordered when a person has signs and symptoms suggestive of an infection with B. burgdorferi and lives in or has visited a region where deer ticks, also known as black-legged ticks, are common, especially when the person has recently been bitten by a tick.

Some early signs and symptoms of Lyme disease may include:

  • A characteristic "bulls-eye" rash that spreads from the site of the bite
  • Fever, chills
  • Headache
  • Fatigue
  • Muscle and joint aches
  • Swollen lymph nodes

If left untreated, Lyme disease may progress to cause:

  • Intermittent muscle and joint pain
  • Neck stiffness and severe headaches (meningitis)
  • Facial weakness and paralysis (Bell's palsy)
  • Weakness and pain in the arms and legs
  • Intermittent arthritis with joint pain and swelling, especially in larger joints like the knees
  • Spells of dizziness or being short of breath
  • Shooting pains, numbness or tingling in the hands or feet
  • Memory loss, difficulty concentrating, and changes in sleep patterns
  • Less commonly, eye inflammation or heart problems such as irregular heartbeat

Enzyme immunoassay (EIA) or immunofluorescence (IFA) tests are ordered first. Western blot testing is ordered as a follow-up test when the first tests are positive or indeterminate.

If initial testing is negative but suspicion of Lyme disease remains high, then testing may be repeated after a few weeks.

When someone does not have typical symptoms or a history of a tick bite and has not been in a region where Lyme disease is prevalent, then the healthcare provider may rule out other causes for the person's symptoms before suspecting and testing for Lyme disease.

What does the Lyme test result mean?

A healthy adult who has never been infected by B. burgdorferi bacteria will not have any antibodies.

If a person has signs and symptoms and the initial EIA or IFA and western blot tests are positive, then it is likely that the person has Lyme disease.

If someone tests positive for only the IgM antibody but negative for IgG and western blot, then the person may have a very recent infection or a false-positive test result.

If an IgM result is not detectable but the IgG and Western blot tests are positive, then it is likely that the person tested either has a later stage infection or had an infection at some time in the past.

If all tests are negative, then either the person's symptoms are due to another cause or the antibody levels are too low to detect at that time; retesting in 2 to 3 weeks may be needed to confirm or rule out infection.

If the IgM and western blot are negative but the IgG is positive, then either the person has recovered from Lyme disease or this is due to cross reactive antibodies and the symptoms are due to another cause.

The following table summarizes results that may be seen with Lyme disease antibody tests.

IgM Antibody IgG Antibody Western Blot Likely Interpretation
Positive Positive Positive Likely Lyme disease if consistent with other signs and symptoms
Positive Negative Negative Early infection or false-positive IgM test due to cross reactive antibodies
Negative Positive Positive Late or previous infection
Negative Negative (usually not performed if IgM and IgG are negative) No infection present; symptoms may be due to another cause or antibody levels are too low to detect
Negative Positive Negative Patient has recovered from prior infection or false-positive IgG test due to cross reactive antibodies

If PCR testing is performed and the result is positive, then it indicates an infection with B. burgdorferi. If the PCR test result is negative, then no infection is present or the levels of DNA are too low to detect.

Additional information about Lyme disease test

Once someone has had Lyme disease, the person will typically have detectable amounts of B. burgdorferi IgG antibodies in their blood for the rest of their life.

Borrelia burgdorferi belongs to a class of bacteria called spirochetes. Other spirochete diseases, such as syphilis and leptospirosis, can cause false-positive results, as can other conditions such as HIV infection, mononucleosis, and a variety of autoimmune disorders.