Short answer · Medically reviewed summary · Last updated: 2026-04-06
Lyme disease is primarily diagnosed through a combination of clinical evaluation, patient history, and two-tiered serological blood testing, as it remains a complex condition that often mimics other illnesses. The Diagnostic Process Diagnosis begins with a thorough physical examination and a detailed history of exposure to tick-infested habitats. If a characteristic erythema migrans (bullseye rash) is present, a physician may diagnose Lyme disease clinically without further testing.
40 people with Lyme Disease have shared their first-person experience on this question at DiseaseMaps.
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How is Lyme Disease diagnosed?
How Lyme Disease is diagnosed: tests, specialists and the diagnostic journey, told by patients and reviewed against medical sources.
Lyme disease is primarily diagnosed through a combination of clinical evaluation, patient history, and two-tiered serological blood testing, as it remains a complex condition that often mimics other illnesses.
The Diagnostic Process
Diagnosis begins with a thorough physical examination and a detailed history of exposure to tick-infested habitats. If a characteristic erythema migrans (bullseye rash) is present, a physician may diagnose Lyme disease clinically without further testing. In later stages, clinicians use a two-tiered testing protocol: an initial enzyme-linked immunosorbent assay (ELISA), followed by a confirmatory Western blot if the first test is positive or equivocal. It is important to note that these tests measure the body’s immune response rather than the bacteria itself, meaning they can yield false negatives in the first few weeks of infection.
The Diagnostic Odyssey
Many patients in our community report a frustrating "diagnostic odyssey," sometimes waiting months or years for an accurate diagnosis. Because Lyme disease symptoms—such as fatigue, joint pain, and cognitive fog—overlap with conditions like fibromyalgia, chronic fatigue syndrome, or multiple sclerosis, it is frequently misdiagnosed. This delay is validly distressing, and we recognize the exhaustion that comes from seeking answers when symptoms are systemic and fluctuating.
Seeking Specialist Care
Because of its multisystem nature, Lyme disease can involve various specialists, including infectious disease experts, rheumatologists, or neurologists. If you feel your symptoms are not being fully addressed, seeking a specialist who is well-versed in the nuances of tick-borne illnesses is vital. A knowledgeable provider will consider the full clinical picture rather than relying solely on blood tests, which have known limitations. Early intervention is key to preventing the long-term complications associated with Lyme disease, so do not hesitate to advocate for a second opinion if you suspect this diagnosis has been overlooked.
Medical Disclaimer: This information is for educational purposes only and does not constitute medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions regarding a medical condition.
References
- Centers for Disease Control and Prevention (CDC): Lyme Disease Diagnosis and Testing
- NIH Genetic and Rare Diseases Information Center (GARD): Lyme Disease
- Orphanet: Lyme Borreliosis
Author: DiseaseMaps Editorial Team
Reviewed against authoritative medical sources (NIH GARD, Orphanet, OMIM)
Last updated: 2026-04-06
Medical disclaimer:
This information does not substitute professional medical advice. Always consult your doctor before making health decisions.
Source:
DiseaseMaps.org
There are blood tests, but there are many false negatives, so often people should be retested if the clinition thinks it's a false negative
גדעון
ILADS physicians are key to proper diagnosis and to order spacific tests that can confirm thier clinical diagnosis. I would highly suggest to NOT go to an IDSA physician at this time in history because they write the treatment guidelines and believe in very limited and closed minded views about the severity of Lyme and associated tick born diseases. Also, the standard blood test that IDSA recommends is highly inaccurate and flawed as to give false negative results to people who are very ill because this is an illness that suppresses the immune system so can go undetected by the normal means of testing.
Posted Feb 26, 2017 by Suzy 850
I got my blood test done privately, as the NHS are rubbish at diagnosis of Lyme
Posted May 9, 2017 by Lynn 1000
Since it is known that there is no test out there available that tells you you Don't have Lyme disease then diagnostics is really the only way to know. I had the bulls eye rash which is hitting the Lyme lottery since that is a positive for Lyme. Yet, conventional testing has never been positive.
Igenex would be my choice to send someone for testing but still not accurate many times.
Lyme needs to come out of the closet. The CDC needs to acknowledge that it is a Pandemic. That it is everwhere, even in our blood supply. That it is sexually transmitted and that you can contract it not only from many types of ticks but from misquitos, biting flies, fleas, sand fleas....Doctors need to be properly educated and not say that there is no chronic Lyme. The whole system is in shambles. Lyme literate doctors that cost thousands to just to see you once, then putting you on years of antibiotics costing more thousands of dollars. Only to have you relapse years down the line. There is no cure for Lyme so research dollars need to be given so we can find a way to fight this along with other dangerous tick borne illnesses.
Igenex would be my choice to send someone for testing but still not accurate many times.
Lyme needs to come out of the closet. The CDC needs to acknowledge that it is a Pandemic. That it is everwhere, even in our blood supply. That it is sexually transmitted and that you can contract it not only from many types of ticks but from misquitos, biting flies, fleas, sand fleas....Doctors need to be properly educated and not say that there is no chronic Lyme. The whole system is in shambles. Lyme literate doctors that cost thousands to just to see you once, then putting you on years of antibiotics costing more thousands of dollars. Only to have you relapse years down the line. There is no cure for Lyme so research dollars need to be given so we can find a way to fight this along with other dangerous tick borne illnesses.
Posted May 11, 2017 by Susan 1270
Lyme literate Doctor should be able to diagnose with symptoms. For tests the Elisa is unreliable. Igenex or Armin labs in Germany are better labs.
Posted May 12, 2017 by Lorraine 1001
A red circle (EM) is 100% contamination, then no test is required. A diagnosis through complaints is a priority because blood tests are not reliable. If someone has a positive antibody test, that one has Lyme. But if the test is negative, it says nothing. Many Lyme patients are tested by means of the LTT test. This is so far the most reliable test. Other patients choose an alternative test as bioresonance or a combination of.
Posted Jul 19, 2017 by A 800
Lyme disease is based on subjective data. It is a clinical diagnosis. If the symptoms fit, then it is rightly diagnosed. The blood tests are more than 40 years old and are notorious for false-negative results. It is a two-tiered testing system including the ELISA with reflex to Western blot. The ELISA has to be positive in order for them to reflexively run a Western blot. More often than not, the ELISA is falsely negative.
Posted Aug 16, 2017 by Deanna 2150
Only a Lyme literate doctor will run the full panel of tests needed to truly find out what's going on. Diagnosing the co-infections is crucial to the proper treatment.
Posted Aug 29, 2017 by missy 2050
There are two maintests that are commonly used, the ELISA and the Western Blot. Both are notoriously unreliable but the Western Blot is better than the ELISA. Other, more reliable tests are available from specialised labs and there are other markers than can be used to indicate likelihood of a borrelia infection. Coinfections also need to be tested for.
Posted Aug 30, 2017 by Alex 600
A clinical diagnosis (based on symptoms and observation) is the best and most reliable method. The is NO lab test or blood work that can be depended on for definitive, conclusive results false-negatives are very common. Finding a "Lyme-literate" practitioner is ideal.
Posted Aug 30, 2017 by S. Guthrie 2000
I did not get a diagnosis until I went to a Lyme Literate Dr. And had The Igenix test.
Posted Aug 31, 2017 by Susan 800
Blood test (NOT Elisa & western blot - very high false negatives), symptom assessment
Communicable disease specialists should be able to help and treat, however the reality is that Lyme literate doctors are difficult to find.
Communicable disease specialists should be able to help and treat, however the reality is that Lyme literate doctors are difficult to find.
Posted Sep 12, 2017 by Sheri 1100
Mostly by a bullseye some where on the body and it seems females are more prone to Lyme than males
Posted Sep 28, 2017 by Darren 400
through a llnd trained by ilads .
Posted Sep 29, 2017 by Sarah 2550
Proper testing through a Doctor who has a real understanding of immune system also someone who knows what to look for Lyme is primarily diagnosed by objective observation and complete history of patient.Testing can be un reliable even though Igrnetics and some other test are now more specific.
Posted Sep 29, 2017 by Katrina 2000
Clinically and through supporting labs
Posted Oct 1, 2017 by Sonya 2000
Very, very tough and that is the tricky part of this disease. The general tests dont work (like ELISA, the method is too old and shows only 20% of correct results.) The patient must find a best private laboratory in Europe or USA to do the testing and has to pay out of his pocket for it.
Posted Oct 9, 2017 by Jessie 1600
Blood test sometimes multiple, you can get false negatives. There is also microscopic blood samples that can be diagnosed and looked at. Some lyme specialist go by history of symptoms.
Posted Oct 25, 2017 by Andrea 2120
Lyme disease is properly diagnosed with blood tests. The patient's blood must be sent to one of only a few labs nationwide that is sensitive enough to give accurate results. Many labs do not give accurate results > false positives or false negatives. Lyme-literate physicians (LLMD) know which labs to send the blood to.
Also, my Lyme-literate physician who diagnosed me after spending 7 years without a diagnosis made a "clinical diagnosis" within 15 minutes of me stepping into his office for the first time. Seven years and many, many doctors who had no clue what was wrong with me. A physician at Stanford University Hospital said to me, "Western medicine is not equipped to find all that is wrong in the body and you are one of those who is slipping through the cracks."
The one symptom upon which my LLMD made his clinical diagnosis was based on the fact that my eyes were ultra-sensitive to light and teared up in sunlight (tears running down my face, even with dark sunglasses on). This symptom does not cross over with other diseases.
After diagnosis, find an alternative-oriented MD who has an Integrative Medicine practice. Also, many of us are helped by a variety of treatments for symptoms: Osteopathic treatment, acupuncture, therapeutic massage, homeopathic treatment, etc.
"The most common diagnostic tests for Lyme disease are indirect ones. They measure the patient's antibody response to the infection, not the infection itself. The two most-used antibody tests are the enzyme-linked immunosorbent assay (ELISA) and the Western blot." - source, LymeDisease.org
Also, my Lyme-literate physician who diagnosed me after spending 7 years without a diagnosis made a "clinical diagnosis" within 15 minutes of me stepping into his office for the first time. Seven years and many, many doctors who had no clue what was wrong with me. A physician at Stanford University Hospital said to me, "Western medicine is not equipped to find all that is wrong in the body and you are one of those who is slipping through the cracks."
The one symptom upon which my LLMD made his clinical diagnosis was based on the fact that my eyes were ultra-sensitive to light and teared up in sunlight (tears running down my face, even with dark sunglasses on). This symptom does not cross over with other diseases.
After diagnosis, find an alternative-oriented MD who has an Integrative Medicine practice. Also, many of us are helped by a variety of treatments for symptoms: Osteopathic treatment, acupuncture, therapeutic massage, homeopathic treatment, etc.
"The most common diagnostic tests for Lyme disease are indirect ones. They measure the patient's antibody response to the infection, not the infection itself. The two most-used antibody tests are the enzyme-linked immunosorbent assay (ELISA) and the Western blot." - source, LymeDisease.org
Posted Nov 4, 2017 by Lisa 500
It’s pathetic. If we follow the CDC they say use their 2 tot test the Elisa and Western Blot. However, on their site it states these were never meant to be used to diagnose Lyme. My question is why such a contradictory statement. I took the western blot and failed 3x it’s a joke since they removed the main definition making us positive. Some get lucky but most wont. I personally prefer Armin Labs out of Germany. Everyone knows they are very intelligent. I took Igenix CDC+ 18,23,24,31,34,39,41, and 83 wasn’t counted though because it was from a mosquito. I still have the scar. DNA Connextions is great too, but Armin Labs found Qfever and nobody else did. However, not many doctors in the USA use it so I’d go Igenix if you have Medicare the basic test is covered then you just need DNA for co-infections. All tests for Lyme, Bartonella, and Babesia are questionable so many do a clinical diagnosis
Posted Mar 9, 2018 by Niki 8100
It’s suppose to be via a 2 tier horrible test that even the CDC says it sent meant to diagnose Lyme disease. Personally, I love Armin Labs out of Germany. They are also the cheapest. Problem is if you are in the USA make sure the doctor you are going to see accepts it. If not you need Igenix and/or DNA Coonxtions
Posted Mar 14, 2018 by Nikolettie 2700
Elisa Test and the Western Blot
Posted May 26, 2018 by Bethany Wing 2100
The gold standard for testing is through IGenex, but still not100% reliable.
If a person gets a bullseye rash following a tick bite, or other insect bite, that is a confirmation of Lyme. No testing required. Absent a rash, known tick bite and positive serology, then Lyme is a clinical diagnosis. A LLMD should be sought out, or Lyme Literate Medical Doctor or other LL practitioner.
If a person gets a bullseye rash following a tick bite, or other insect bite, that is a confirmation of Lyme. No testing required. Absent a rash, known tick bite and positive serology, then Lyme is a clinical diagnosis. A LLMD should be sought out, or Lyme Literate Medical Doctor or other LL practitioner.
Posted Feb 1, 2020 by Lori 2550
With analytics like those of Arminlabs and Redlabs, the analytics of Elisa, Immunoblot etc give many false negatives
Posted Dec 16, 2021 by José 7770
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Examen de sangre con wetern blot, ELISa, y PCR
Posted Feb 26, 2017 by achita 500
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Analysis of blood such as: ELISA, WESTERN BLOT, and PCR.
Posted Feb 26, 2017 by Achita 1050
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Laboratory tests blood
IgG IgM to borrelia
ELISA for borrelia
Wester blod for borrelia and co-infections
IgG IgM to borrelia
ELISA for borrelia
Wester blod for borrelia and co-infections
Posted Feb 28, 2017 by Leva Méndez 3122
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examen clinique
western blot
western blot
Posted Mar 6, 2017 by laurence 1000
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Is derived infectologia and one d studies is the pruebad elisa
Posted Mar 10, 2017 by Erika 400
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The first test is the ELISA test , then the westerm blot , vecesdan false negatives . If there has been exposure to ticks at times the diagnosis is clinical . The specialists should be the units of infectious hospitals , supported by internal medicine , neurologists , rheumatologists .
Posted Mar 23, 2017 by Fátima Marrero campos 1264
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The most well known are ELISA, which is not recommended by result in many false negatives.
Also by the method of Western Blot and PCR.
Also by the method of Western Blot and PCR.
Posted Apr 29, 2017 by Andrea Díaz 850
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Through an analysis of specific blood.
In Spain, the laboratories are not sensitive enough to give values credible.
Out of doubts, you could test with a specific blood panel in which looking for anti-bodies to borrelia burgdorferi IGM and IGG in the blood. A doctor of internal medicine could mandártelo, but it is very high the probability of a false negative, so if your symptoms continue and you don't find a diagnosis (or have you been diagnosed with any illness, without testing) I did by sending my blood to the lab Armin Labs, in Germany.
In Spain, the laboratories are not sensitive enough to give values credible.
Out of doubts, you could test with a specific blood panel in which looking for anti-bodies to borrelia burgdorferi IGM and IGG in the blood. A doctor of internal medicine could mandártelo, but it is very high the probability of a false negative, so if your symptoms continue and you don't find a diagnosis (or have you been diagnosed with any illness, without testing) I did by sending my blood to the lab Armin Labs, in Germany.
Posted Aug 23, 2017 by Cecilia 2263
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Using a specific test called the ELISA.
Posted Sep 12, 2017 by N6 2550
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Through an analysis of blood, according to the country it is the method in Argentina is used IFI and ELISA, in Europe or the US used the WESTERN BLOT.
Posted Sep 13, 2017 by mora de La Plata 1500
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official test: elisa, wester blot and pcr. and then the same for each coinfección
Posted Sep 15, 2017 by Emiliano Ignacio Rodriguez 2500
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Analytical,
Tests of eyes
Tests of eyes
Posted Sep 27, 2017 by Amparochiqui 2000
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issues dun erytheme migrans, serological tests ,symptoms, examination,urinary, skin biopsy, examines the tick that has bitten..it must be frozen and sent to the veterinary laboratory,The lumbar puncture
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Unfortunately, the evidence is not recognised medically. In my case, I did do several blood tests during the course of the disease, just after the tick bite and then up to a year later, with the appearance of IGG and IGM (or the opposite, I do not know). My doctor to me has diagnosed Lyme immediately, and the infectiologist of the CHU Liège also. By contrast, the doctor of the mutual do not recognize such evidence and told me that the blood test does not mean that I am sick, but that simply, I had, one day, a contact with the Lyme bacteria, which is shocking. My family doctor, in addition to be based on the analyses of blood, is based also on the presence of symptoms in his patient, according to the list of dr. Horowitz.
Posted Oct 1, 2017 by Marie-Pierre 1000
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Elisa
Western blot
Symptomatology and clinical course of the patient
Test of bacteria, virus and parasites
Trained doctor Lyme
Chronimed
Western blot
Symptomatology and clinical course of the patient
Test of bacteria, virus and parasites
Trained doctor Lyme
Chronimed
Posted Oct 1, 2017 by Linda 1000
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By the tables of the clinical symptoms of Dr Horowitz
By a blood test done in Germany
A physician trained/educated in this disease is essential because the other denies the disease or you are losing time and money in turning around the pot so that they do not believe you or judging you.
By a blood test done in Germany
A physician trained/educated in this disease is essential because the other denies the disease or you are losing time and money in turning around the pot so that they do not believe you or judging you.
Posted Oct 2, 2017 by Aurore 1000
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The erythme Migrant is the signature of the Lyme disease, demonstrating that the bacteria have multiplied...
Therefore, the patient should be treated with antibiotic therapy, although on me it did not work...
Therefore, the patient should be treated with antibiotic therapy, although on me it did not work...
Posted Oct 2, 2017 by Yas 1000
