From the Research
Repeat Lyme disease testing should be performed 4-6 weeks after initial testing if the first test was negative but clinical suspicion remains high, as this timing allows for the development of detectable antibodies, which may yield false negatives due to the delay in antibody response 1.
Key Considerations
- The standard two-tier testing approach involves an initial ELISA or EIA test followed by a Western blot if positive.
- When repeating tests, both tiers should be performed again to maximize diagnostic accuracy.
- Testing should not be repeated to monitor treatment response, as antibodies may persist for months or years after successful treatment 2.
- Additionally, repeat testing is not recommended for patients with previously confirmed Lyme disease who develop new symptoms, as the tests cannot distinguish between past and current infections 3.
Rationale
The rationale for this timing is based on the immunological response to Borrelia burgdorferi infection, which typically takes several weeks to develop detectable antibody levels 4.
Clinical Judgment
Instead, clinical judgment should guide treatment decisions in these cases, taking into account the patient's symptoms, medical history, and epidemiological factors 5.
Testing Algorithms
Modified two-tiered testing algorithms have been evaluated, and the VlsE/C6 MTTT offers an additional laboratory testing algorithm for LD with equivalent or enhanced performance compared to that of the other MTTTs and STTTs evaluated in this study 4.
Limitations
It is essential to note that serologic testing has limitations, including background false positivity, and is recommended only when there is at least a one in five chance that the patient has active Lyme disease 2.