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What is the Most Accurate Test for Lyme Disease?

Updated on: July 15, 2021
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Lyme disease is caused when a tick infected with bacteria called Borrelia burgdorferi and Borrelia mayonii bites you. The tick bite transfers bacteria into your body and leads to an infection.

Lyme disease is serious and makes life miserable for some people. The most common symptoms include:

  • Bulls-eye pattern skin rash
  • Migraine
  • Fever
  • Joint and muscle pain
  • Stiffness in the neck

Additionally, some people infected with Lyme disease present unusual symptoms that are confused with other diseases and conditions. In fact, some doctors administer a Lyme disease test even if Lyme is not immediately suspected. The symptoms mimic so many other diseases and create confusion when treating someone with a difficult-to-diagnose condition. 

What is the Most Accurate Test for Lyme Disease? 1

Testing for Lyme rules out the disease when it’s probably not the case and increases the odds of an accurate Lyme disease diagnosis. In some cases, doctors have been surprised to learn Lyme actually was the culprit of the patient’s symptoms.

Left untreated, Lyme can develop into debilitating chronic conditions. This is why it’s so important to investigate a potential infection extensively. 

Untreated Lyme disease is linked to:

  • Inflammatory arthritis
  • Meningitis
  • Neurological problems 
  • Heart ailments 
  • Encephalopathy

These issues can develop in the span of weeks, months, or years.

There are multiple antibody tests available for Lyme disease. What is the most accurate blood test for Lyme disease?

ELISA Test

The ELISA test or Enzyme-linked immunosorbent assay test is a blood test for Lyme disease. It detects the presence of the antibodies made by the body's immune system against the bacteria. 

This is a reasonably accurate test but it’s not perfect and sometimes gives a false- positive or negative result. This is true especially if it is administered too early and the antibodies are not yet present. 

Western Blot

The Western Blot test is given after the ELISA test, usually if there is a positive ELISA result. This test detects proteins of antibodies in the blood more accurately than ELISA. It’s also an option if the ELISA is negative, but there is strong evidence the patient has Lyme disease. 

This test is considered more accurate than the ELISA test because it’s qualitative. It looks specifically for the antigens Borrelia burgdorferi in the immune system. It not only measures your immune response, it evaluates it for exactly what it contains.

Depending on your results from the Western Blog test and your symptoms, your doctor might also order one or more additional tests, including:

  • Electrocardiogram
  • Echocardiogram
  • MRI 
  • Lumbar puncture

Are Lyme Disease Tests Accurate?

Yes and no.

The key to an accurate Lyme disease test – and any other serological test – is timing. To get accurate results, the body must have time to develop antibodies. 

What is the Most Accurate Test for Lyme Disease? 2

It might seem as if this would be easy. A tick bites someone, shortly after they develop symptoms, doctors administer a test, and they know if they have Lyme disease. But it isn’t that simple. 

Sometimes the body hasn’t produced antibodies even if symptoms are present. Sometimes patients don’t even develop typical Lyme disease symptoms, so it’s difficult to know when or if to administer the test. If a patient does not develop migraines, testing won’t be able to confirm an infection for at least four weeks after becoming ill. The delay of diagnosis means there will likely be an increased chance of persistent symptoms.

Another issue that arises with Lyme disease testing is its inability to confirm a cure. Even after someone heals, antibodies persist and you’ll get a positive test result. This is a possibility for months or years after treatment. This can result in two issues:

  1. If someone suspects reinfection months or years later, the serological test might not do any good. The antibodies are present but might be linked to the first infection.
  2. If someone is exhibiting Lyme’s symptoms and had Lyme months or years ago but that is not the problem now, the test could prevent or extend an accurate diagnosis of the current problem.

According to the CDC, a test is only helpful when used appropriately. The organization recommends using a combination of serological testing and objective evaluation. Doctors should ask patients of the likelihood they’ve been exposed to ticks and to evaluate whether symptoms are linked to other causes. Examinations should include a full medical history evaluation and patients should fit the clinical symptoms known to be associated with Lyme disease. Even then, it remains challenging to determine if the patient group is representative of all Lyme patients.

Ultimately, it’s impossible to say with certainty what is the most accurate test for Lyme disease. This is because it is extremely difficult to come to definite conclusions about accuracy without a gold standard.


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Lyme Disease. 2018, www.cdc.gov/lyme/index.html.

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