Quick answer
Yes, there is a test for Lyme disease. It is usually a blood test that looks for antibodies your body makes against Lyme bacteria. CDC recommends a two-step process using FDA-cleared tests, often run on one blood sample. Antibodies take weeks to form, so early tests can be negative, and a typical Lyme rash is usually diagnosed without a test.
- CDC recommends a two-step antibody test. Both steps are needed, and both can use the same blood sample. If the first step is negative, testing stops there.
- Antibody tests may be falsely negative during the first 4 to 6 weeks after infection.
- For a typical erythema migrans (EM) rash in someone who may have been exposed to ticks in an area where Lyme is common, the 2020 IDSA/AAN/ACR guideline recommends a clinical diagnosis rather than lab testing.
- CDC does not recommend tests that have not been cleared or approved by the FDA.
How Lyme disease testing works
Lyme disease tests usually do not look for the bacteria themselves. Instead, they look for antibodies, the proteins your immune system makes after it meets Borrelia burgdorferi, the main germ behind Lyme disease in the U.S.
CDC recommends doing this in two steps. There are two accepted ways to run them:
- Standard two-tier testing. Step one is an enzyme immunoassay (EIA, sometimes called ELISA). If that is positive or unclear (equivocal), step two is a Western blot.
- Modified two-tier testing. Both steps are EIAs, using two different tests. CDC notes that labs are using this approach more and more.
Either way, the overall result counts as positive only when the first step is positive or equivocal and the second step is positive. You usually do not need two separate blood draws, because both steps can run on the same sample.
When to get tested, and why early tests can be negative
Timing matters more than most people expect. Your body needs several weeks to make enough antibodies to show up on a test. CDC says FDA-cleared tests work well after about 4 to 6 weeks, and that testing too soon can give a false negative. Early antibiotic treatment can also make it less likely that antibodies ever show up.
This is why a classic expanding rash after a tick bite is usually diagnosed by looking at it, along with your history. Learn what that rash can look like on our Lyme disease rash page.
Testing right after a tick bite, before any symptoms, is generally not helpful. The 2020 IDSA/AAN/ACR guideline recommends against testing people who have no symptoms after a tick bite, because a positive result most likely reflects past exposure or a false positive. If you were just bitten, see our tick bite guide instead.
See a healthcare provider if you develop an expanding rash, fever, chills, headache, fatigue or aches in the days to weeks after a tick bite. Tell them when and where you were likely bitten. Seek urgent care for facial drooping, heart palpitations, fainting, shortness of breath, or a severe headache with a stiff neck.
Reading your Lyme disease blood test results
Your provider will read your results alongside your symptoms and your chance of tick exposure. This simple table shows how the two-step result usually comes together.
| Step 1 (EIA) | Step 2 (Western blot or second EIA) | Overall result | What it usually means |
|---|---|---|---|
| Negative | Not done | Negative | No antibodies found. Early in an infection, this can still miss Lyme. |
| Positive or equivocal | Positive (or equivocal for some tests) | Positive | Antibodies to Lyme bacteria were found. Your provider weighs this with your symptoms and exposure. |
| Positive or equivocal | Negative | Negative | The first result was not confirmed by the second step. |
A few other things CDC points out:
- IgM and IgG. Some reports list IgM and IgG results separately. These are two kinds of antibodies. CDC says a positive IgM result should be disregarded if you have been sick for more than 30 days.
- Antibodies can linger. Once positive, antibody levels can stay up for months to years, even after the bacteria are gone. So a test cannot show whether treatment worked.
- False positives happen. Other conditions can cross-react, including relapsing fever, syphilis, rheumatoid arthritis and Epstein-Barr virus infection.
- A positive test does not protect you. Having antibodies does not reliably prevent getting Lyme disease again.
What is the most accurate test for Lyme disease?
No Lyme test is perfect, and how well a test works depends on the stage of illness. Here are the two main views, labelled so you can see who says what.
Mainstream view (CDC, IDSA/AAN/ACR). The recommended approach is two-step testing with FDA-cleared tests, either standard or modified. CDC says it will only recommend new tests after the FDA clears them. For a typical EM rash, the guideline recommends a clinical diagnosis, since antibody tests are often negative that early.
Patient-advocate view (ILADS). The International Lyme and Associated Diseases Society argues that Lyme is mainly a clinical diagnosis, that antibody tests can miss cases (especially early or in some patients), and that two-tier testing does not serve patients well. ILADS says no single test result should outweigh the full clinical picture.
Both views agree on one practical point: your symptoms, your exposure history and a clinician’s exam matter, not just a lab number.
Tests CDC does not recommend
CDC currently advises against Lyme tests that are not cleared or approved by the FDA, which some labs that do not accept insurance may offer. In an earlier public caution, CDC flagged these practices because their accuracy and usefulness had not been established:
- Urine antigen tests
- Immunofluorescent staining for “cell wall-deficient” forms of the bacteria
- Lymphocyte transformation tests
- PCR tests on unsuitable samples, such as blood or urine
- Western blots read using criteria that have not been validated and published
The 2020 guideline also recommends against testing a removed tick for Lyme bacteria. CDC adds that there is no evidence ticks spread Bartonella or Mycoplasma, which some providers test for.
At-home Lyme disease test kits
You may see at-home Lyme disease test kits sold online. Many are collection kits: you prick your finger, mail a blood sample to a lab, and get results online. We do not recommend or link to any brand.
If you are considering one, these questions can help:
- Does the lab use FDA-cleared tests in the two-step process CDC recommends?
- Will a licensed clinician review the results with you?
- Were you tested too early? A negative result in the first few weeks may not rule Lyme out.
Whatever the result, share it with a healthcare provider. A home kit cannot examine a rash, weigh your symptoms, or prescribe treatment.
How to get tested for Lyme disease near you
Most Lyme disease testing is ordered by a clinician, and the blood is drawn at a clinic or lab. Common places to start:
- Primary care. Your regular doctor, nurse practitioner or physician assistant can examine you, order testing and follow up.
- Urgent care. A good option if you have a new rash or fever and cannot get a quick appointment.
- Telehealth. A virtual visit can review photos of a rash and your history. If testing is needed, the clinician can send an order to a local lab.
Bring the date of the bite (if you know it), where you were, photos of any rash, and a list of symptoms. Your local health department is a good source for information on tick-borne diseases in your area. To check how common Lyme is where you live, see our risk map.
We are collecting real experiences about getting tested for Lyme disease from people who have lived it, shared with their permission. As stories come in, they will appear here, clearly marked as personal experience rather than medical advice.
Testing is one part of the picture. For what happens next, read about symptoms and testing and Lyme disease treatment.
Frequently asked questions
Is there a test for Lyme disease?
Yes. The standard test is a blood test that looks for antibodies to Lyme bacteria, done in two steps. It works best several weeks after infection. Early on, especially with a typical rash, clinicians often diagnose Lyme based on the rash and your history.
How do you test for Lyme disease?
A clinician orders a blood test. The lab runs a first antibody test (an EIA), and if it is positive or unclear, a second test on the same sample: a Western blot or a second EIA. Both must be positive for the overall result to be positive.
What is the most accurate test for Lyme disease?
There is no perfect test. CDC and the IDSA/AAN/ACR guideline recommend two-step testing with FDA-cleared tests. Accuracy depends on timing: tests often miss very early infection. Patient advocates, including ILADS, stress clinical diagnosis because tests can miss cases.
Can a Lyme test be negative if I have Lyme disease?
Yes, especially in the first 4 to 6 weeks, before antibodies form. If you tested early and still have symptoms, ask your provider whether testing again later makes sense.
Should I get a Lyme test right after a tick bite?
Usually not. The 2020 guideline recommends against testing people with no symptoms after a tick bite, because the result does not help guide care. Watch for a rash or fever over the next few weeks and see a provider if they appear.
Should I send the tick to be tested?
CDC and the 2020 guideline do not recommend it. A positive tick does not mean you were infected, and a negative tick can give false reassurance. Results also often come back after symptoms would appear.