What If Your Lyme Disease Test Is Positive
Its important to note that a positive result doesnt mean you have a diagnosis of Lyme disease. The tests will show that antibodies are present in your blood, but a doctor will need to order another type of test before you get an official diagnosis.
If someone gets a positive at-home test, definitely see your doctor, says Dr. Puja Uppal, a board certified family medicine physician and the chief medical officer at Think Healthy.
The Blood Tests Can Have False Positives
The blood tests can trigger false positives, suggesting that you have the disease when you really dont. This can happen in up to one out of four tests.
This can lead to unnecessary treatment with antibiotics. These drugs are usually safe, but they sometimes cause side effects, such as nausea, vomiting, diarrhea, and increased sensitivity of the skin to sunlight. In rare cases, they can even cause dangerous allergic reactions.
Using too many antibiotics can also lead to the growth of drug-resistant bacteria. This means that bacteria in your body may get stronger and more difficult to treat with antibiotics in the future.
A false positive can also lead to more unneeded blood tests, urine tests, X-rays, and doctor visits.
If you have a false positive, you may not get treated for the real cause of your pain. For example, rheumatoid arthritis is a disease that causes joint pain. It can lead to permanent and severe joint damage if you do not start taking the right medicines as early as possible.
Who Should Not Be Tested
The American College of Physicians recommends against testing in patients:
Presenting with nonspecific symptoms without objective signs of Lyme disease
With low pretest probability of infection based on epidemiologic exposures and clinical features
Living in Lyme-endemic areas with no history of tick exposure
Presenting less than 1 week after tick exposure
Seeking a test of cure for treated Lyme disease.
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Symptoms Of Lyme Disease
Signs and symptoms of Lyme disease can vary from person to person after being bitten by a tick.
Lyme disease occurs in stages. The signs and symptoms of each stage can overlap. In some people, Lyme disease may present in a later stage without a history of prior signs or symptoms.
The most commonly reported sign of Lyme disease is an expanding skin rash that typically begins at the site of the tick bite. This rash is called erythema migrans. It slowly grows to more than 5 cm in diameter over several days, and can sometimes:
- be circular or oval-shaped
- look like a target or bull’s eye
- go unnoticed, especially if it’s on:
- dark skin
- a part of the body that’s difficult to see
Some people may not develop a rash.
Other early signs and symptoms include:
If left untreated, the infection could spread to the joints, heart and nervous system.
Images of erythema migrans rash
Image 1Footnote a: A rash that looks like a bull’s eye at the site of a tick bite.
Image 2Footnote a: An oval-shaped red rash.
Image 3Footnote a: A red rash that has expanded across the width of a limb.
Image 4Footnote a: A red rash and blisters on a forearm.
Image 5Footnote b: A rash on a shoulder.
Image 6Footnote c: A rash on the back of a knee.
- Footnote a
Later symptoms of Lyme disease can appear days to months after an infected tick bite, and may include:
- more rashes
- migratory pain that spreads in the:
Key Points To Remember
- Most Lyme disease tests are designed to detect antibodies made by the body in response to infection.
- Antibodies can take several weeks to develop, so patients may test negative if infected only recently.
- Antibodies normally persist in the blood for months or even years after the infection is gone therefore, the test cannot be used to determine cure.
- Infection with other diseases, including some tickborne diseases, or some viral, bacterial, or autoimmune diseases, can result in false positive test results.
- Some tests give results for two types of antibody, IgM and IgG. Positive IgM results should be disregarded if the patient has been ill for more than 30 days.
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Alternative Diagnostic Tests Not Available At Ripl
Tests used by the NHS and UKHSA to identify Lyme disease are well characterised, standardised, and are highly reproducible between laboratories. They are the methods of choice recommended in the 2018 NICE Lyme disease guidelines, following an extensive review of the evidence and literature. International external quality assurance schemes are in place to ensure consistency between different centres offering these tests.
Several private laboratories in Europe and the US offer an alternative type of test called an ELISpot to diagnose Lyme disease. This looks for different markers in blood samples compared to conventional validated Lyme disease serology tests. The laboratories using these tests in the diagnosis of Lyme disease do not publish their methods, and have not produced peer reviewed publications on their clinical value.
This makes it very difficult to verify their results, especially as there are no national or international EQA schemes for Lyme disease ELISpot tests and therefore no independent verification of performance between laboratories. Without independent evidence it is impossible to determine the validity of results produced using these alternative tests.
RIPL cannot interpret the results of alternative diagnostic tests.
Limitations Of Serologic Tests For Lyme Disease
Currently available serologic tests have inherent limitations:
Antibodies against B burgdorferi take at least 1 week to develop
The background rate of seropositivity in endemic areas can be up to 4%, affecting the utility of a positive test result
Serologic tests cannot be used as tests of cure because antibodies can persist for months to years even after appropriate antimicrobial therapy and cure of disease thus, a positive serologic result could represent active infection or remote exposure
Antibodies can cross-react with related bacteria, including other borrelial or treponemal spirochetes
False-positive serologic test results can also occur in association with other medical conditions such as polyclonal gammopathies and systemic lupus erythematosus.
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Should You Get A Test For Lyme Disease
If Lyme disease is treated soon after a tick bite, the outlook is great. Most cases of Lyme disease respond to a 2- to 4-week round of antibiotics.
If Lyme disease goes untreated, it can be more difficult to eliminate. For some, it can lead to inflammation of the joints, heart, and nervous system. Progression of the disease, and its severity, can vary from person to person.
Lyme disease is staged in categories: acute, early disseminated, and late disseminated. Later stages of Lyme disease may involve multiple systems in the body.
The most common sign of Lyme disease is an erythema migrans, or bulls-eye rash. The rash often appears after a delay of 3 to 30 days after the tick bite, according to the
- neck pain
- sore throat
With disseminated Lyme disease, symptoms can also include neurologic conditions, such as cranial nerve palsy and meningitis that mimics aseptic meningitis. Heart inflammation can also be a sign of Lyme disease.
If youre experiencing any of these signs or symptoms, an at-home test may help you identify Lyme disease. With the click of a button, a test can be shipped to your front door.
These tests may come in handy if youre an avid outdoors person who lives in geographical areas where ticks are present.
When choosing at-home Lyme disease tests to feature, we looked at affordability, accuracy, ease in reading directions, and what made the specific tests stand out from the crowd.
To select the best tests, we look at studies and user reviews.
What Does An At
Once ordered, an at-home Lyme disease test kit is delivered to your home, where you can collect the sample privately and comfortably. The kit will include the instructions, the sample collector, and the box to return the sample.
Once the results are ready, you will receive them in your email or through the company’s online portal, or they will be sent to your doctors office.
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Choosing A Lyme Disease Test
Often the diagnosis of Lyme disease depends upon the physicians readiness to listen and ask questions and on the mutual exchange of information, beginning with the initial doctor-patient interview.
Often the diagnosis of Lyme disease depends upon the physicians readiness to listen.
Lyme disease should be diagnosed clinically, without reliance on testing. However, all too often, physicians will ignore clinical presentations if laboratory tests are negative. Yet there are numerous scientific articles documenting false negatives and low sensitivity of such tests.
There can be several reasons for the inaccurate results. The sensitivity of the tests varies greatly depending upon how long an individual has been infected and on the type of clinical manifestations. If a patient has received antibiotics in the early stage of the disease, antibody levels may be too low to be detected or nonexistent. Antibodies to Borrelia burgdorferi do not appear in the blood until several weeks after the tick bite. The Lyme bacteria are not always present in the blood. The person could have been infected with a strain of Bb that is not covered in testing.
That said, laboratory tests can be used to support the diagnosis. Because of the varied presentations and necessity of relying on a patients symptoms, several tests may be helpful.
The ELISA and Western blot are the most common tests used to diagnose Lyme disease. Both tests measure antibodies to Bb, the bacterium that causes Lyme disease.
If The C6 Test Is Positive What Is The Next Step
A positive C6 test means antibodies to C6 were found. The next step is to do a QC6 test, which determines if the levels of antibody are high enough to justify treatment. If the value of the QC6 is higher than 30 IU/mL and signs of illness are present, then antibiotic treatment should be considered. If the QC6 is less than 30 IU/mL and there are no signs of illness, then treatment may not be necessary.
In addition to doing the QC6 test, your veterinarian may want to take samples of blood and urine to assess kidney function and to look for protein in the urine. A positive test for protein in the urine could signal serious underlying kidney disease.
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How Will Pregnancy Affect Treatment For Lyme Disease
Early treatment of Lyme disease during pregnancy is important. Thats because if Lyme disease is untreated, it can affect the placenta. According to the CDC , transmission of Lyme disease from mother to fetus is possible, though rare.
For pregnant people, treatment includes a round of antibiotics. Certain treatments for Lyme disease may not be used, as they can affect the fetus. If you suspect that you have Lyme disease, talk with a healthcare professional immediately.
Lyme Disease Signs And Symptoms
Most symptoms of Lyme disease in humans usually appear between three and 30 days after a bite from an infected blacklegged tick.
You should contact your local public health unit or speak to a health care professional right away if you have been somewhere that ticks might live and experience any of the following symptoms:
- a bulls-eye rash (a red patch on the skin that is usually round or oval and more than 5 cm that spreads outwards and is getting bigger
- a bruise-like rash
- spasms, numbness or tingling
- facial paralysis
If not treated, Lyme disease can make you feel tired and weak and, if it gets really bad, it can even harm your heart, nerves, liver and joints. Symptoms from untreated Lyme disease can last years and include recurring arthritis and neurological problems, numbness, paralysis and, in very rare cases, death.
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What Do The Results Mean
The Centers for Disease Control and Prevention recommends a two-test process of your sample:
- If your first test result is negative for Lyme disease, you don’t need any more testing.
- If your first result is positive for Lyme disease, your blood will get a second test.
- If both results are positive for Lyme disease and you also have symptoms of infection, you probably have Lyme disease.
Positive results don’t always mean a Lyme disease diagnosis. In some cases, you can have a positive result but not have an infection. Positive results may also mean you have an autoimmune disease, such as lupus or rheumatoid arthritis.
If your lumbar puncture results are positive, it may mean you have Lyme disease, but you might need more tests to confirm a diagnosis.
If your health care provider thinks you have Lyme disease, he or she will prescribe antibiotic treatment. Most people who are treated with antibiotics in the early stage of disease will make a complete recovery.
Other Lyme Disease Tests
Three other tests that may be used to diagnose Lyme disease are polymerase chain reaction , antigen detection and culture testing. They are called direct tests because they detect the bacteria, not just your immune response to it.
PCR multiplies a key portion of DNA from the Lyme bacteria so that it can be detected. While PCR is highly accurate when the Lyme DNA is detected, it produces many false negatives. This is because the Lyme bacteria are sparse and may not be in the sample tested.
Antigen detection tests look for a unique Lyme protein in fluid . Sometimes people whose indirect tests are negative are positive on this test.
Culture is the gold standard test for identifying bacteria. The lab takes a sample of blood or other fluid from the patient and attempts to grow Lyme spirochetes in a special medium.
Although culture tests are generally accepted as proof of infection, the CDC has advised caution on the only commercially available culture test developed by Advanced Laboratory Services. LDo recognizes that the test is new and requires further validation in other studies. However, we believe that informed patients should be able to choose the test if they prefer. Choice is particularly important given the low quality of Lyme disease tests generally.
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Completion Of Lyme Disease Test Request Form
Diagnostic samples must be submitted with a completed RIPLLyme disease test request form . Please use a single request form for each patient even when sending several samples.
Please provide details of the sample type, patients symptoms and onset date, tick bite or exposure history and, if relevant, travel and treatment history. Symptom onset date is particularly important for interpretation of laboratory results.
When sending CSF, please provide the cell count and total albumin, IgG and IgM levels for the CSF and serum pair, if available.
Ideally the clinician who sees the patient should print out and complete the appropriate request form . Send the request to the local laboratory with the clinical sample along with a local laboratory request form, whether this is paper or electronic.
The local laboratory should complete the senders information on the request form and then forward the completed form and sample to RIPL. Before sending samples, clinicians are advised to liaise with their local laboratory because local arrangements may vary.
If only immunoblot confirmation is required because the local laboratory has already obtained a positive Lyme screening test result on the serum sample being submitted, tick the Line blot confirmation only box and write the positive screening test result below.
Who Should Get Testing
Testing is usually indicated if a person has symptoms of Lyme disease and a known or possible exposure to ticks that can carry the Borrelia bacteria. However, because it takes time for antibodies to develop, the timing of testing is important to consider.
Lyme disease symptoms depend on the extent of the bacterial infection. Three phases are used to describe the infection:
It is important to understand these phases because testing is not equally valuable in each stage. With early localized disease and erythema migrans, blood testing is generally not helpful because antibodies have not had enough time to develop.
Because of similar concerns about potential false positive results, random screening for Lyme disease in people without symptoms is not recommended even in areas that are known to have ticks that can carry the Borrelia bacteria.
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How Is Lyme Disease Treated
Common antibiotics are effective at clearing the infection and early symptoms and in helping to prevent the development of complications. If untreated, the disease will progress to a longer-term form in about half of patients. Antibiotics are generally given for up to three weeks. If complications develop, intravenous antibiotics may need to be used to treat the infection. The bacteria can survive for long periods in the body even if no symptoms develop. If untreated, the bacteria can cause chronic irritation in in a number of the bodys organs. That is why early diagnosis and treatment with antibiotics is important.
Cdc Supports The Development Of New Tests
New tests may be developed as alternatives to one or both steps of the two-step process. Before CDC will recommend new tests, they must be cleared by the Food and Drug Administration . For more details, see: Recommendations for Test Performance and Interpretation from the Second National Conference on Serologic Diagnosis of Lyme Disease.
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