Diagnosis of Lyme Disease
by Editorial Staff And Contributors
The diagnosis of Lyme disease is usually based on the presence of symptoms and signs of the disease. If you have removed an attached tick from your body, tell your doctor. For 30 days after being bitten, you should watch closely for the characteristic “bulls-eye” rash at the site of the bite, or a fever. If you think you have developed these or any other symptoms, see your doctor immediately. You are much less likely to develop Lyme disease if the tick had been attached to you for less than 24 hours. Treatment with appropriate antibiotics after a tick bite, while not endorsed by all experts, may also reduce your risk.
Presently, there are no tests that are completely accurate in diagnosing Lyme disease. However, your doctor may order one or more of the following tests to support the diagnosis of Lyme disease:
Antibodies are the body’s defense against an infection. If you have been infected with the Lyme disease bacteria, your body will release specific antibodies to fight it. It takes about 4 weeks or more for these antibodies to become detectable. Examples include:
Both of these tests can have false negative results (the test is negative even though you are infected) or false positive results (the test is positive even though you are not infected).
Some reasons why false negatives may occur include:
Some reasons why false positives may occur include:
Direct Detection Tests
These tests look directly for the bacteria, or pieces of it, in the blood and other fluids of the body, such as urine and spinal fluid. Two main types are:
This test is done by actually growing the Lyme bacteria from fluid taken from an open sore or other source of body fluids. If the bacteria grow, the test is considered positive. Cultures often take many weeks to grow the bacteria and are rarely used today.
Analysis of Spinal Fluid TOP
This test is done when your symptoms indicate that Lyme disease is affecting the nervous system. Spinal fluid is tested for bacteria using one of the tests listed above. During a lumbar puncture, a needle is inserted into the spinal column to remove the fluid.
Single Photon Emission Computed Tomography (SPECT) TOP
This test is rarely used, but may be done in certain cases with symptoms that involve the nervous system. It is a kind of brain scan that looks for brain wave patterns that may indicate Lyme disease infection.
A history of Lyme disease, symptoms, diagnosis, treatment, and prevention. National Institute of Allergy and Infectious Diseases website. Available at:
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Updated March 29, 2011. Accessed September 26, 2012.
Diagnosis and testing. Centers for Disease Control and Prevention website. Available at:
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Updated July 26, 2012. Accessed September 26, 2012.
Lyme disease. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T114365/Lyme-disease . Updated August 15, 2016. Accessed October 6, 2016.
Lyme disease diagnosis. Lyme Disease website. Available at: https://www.lymedisease.org/lyme-basics/lyme-disease/diagnosis. Accessed September 26, 2012.
Marques AR, Martin DS, Philipp MT. Evaluation of the C6 peptide enzyme-linked immunosorbent assay for individuals vaccinated with the recombinant OspA vaccine. J Clin Microbiol. 2003;40(7):2591-2593.
Philipp MT, Marques AR, Fawcett PT, Dally LG, Martin DS. C6 test as an indicator of therapy outcome for patients with localized or disseminated lyme borreliosis. J Clin Microbiol. 2003;41(11):4955-4960.
Last reviewed November 2018 by David L. Horn, MD
Last Updated: 12/20/2014
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