Lyme disease blood test

Lyme disease serology; ELISA for Lyme disease; Western blot for Lyme disease

The Lyme disease blood test looks for antibodies in the blood to the bacterium (Borrelia burgdorferi) that causes Lyme disease. The test is used to help diagnose Lyme disease.

How the Test is Performed

A blood sample is needed.

A lab specialist looks for Lyme disease antibodies in the blood sample using the ELISA test. If the ELISA test is positive, it must be confirmed with another test called the Western blot test.

How to Prepare for the Test

You do not need to take special steps to prepare for this test.

How the Test will Feel

When the needle is inserted to draw blood, some people feel moderate pain. Others feel only a prick or stinging. Afterward, there may be some throbbing or a slight bruise. This soon goes away.

Why the Test is Performed

The test is done to check for the diagnosis of Lyme disease.

Normal Results

A negative test result is normal. This means none or few antibodies to Lyme disease were seen in your blood sample.

Normal value ranges may vary slightly among different labs. Some labs use different measurements or test different samples. Talk to your health care provider about the meaning of your specific test results.

What Abnormal Results Mean

A positive ELISA result is abnormal. This means antibodies were seen in your blood sample. But, this does not confirm a diagnosis of Lyme disease. A positive ELISA result must be followed up with a Western blot test. Only a positive Western blot test can confirm the diagnosis of Lyme disease.

For many people, the ELISA test remains positive, even after they have been treated for Lyme disease and no longer have symptoms.

A false positive ELISA test may also occur with certain diseases not related to Lyme disease, such as rheumatoid arthritis.

Risks

There is little risk involved with having your blood taken. Veins and arteries vary in size from one person to another and from one side of the body to the other. Taking blood from some people may be more difficult than from others.

Other risks associated with having blood drawn are slight but may include:

Fainting or feeling lightheaded
Lightheaded
Dizziness is a term that is often used to describe 2 different symptoms: lightheadedness and vertigo. Lightheadedness is a feeling that you might fai...
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Multiple punctures to locate veins
Hematoma (blood buildup under the skin)
Hematoma
A bruise is an area of skin discoloration. A bruise occurs when small blood vessels break and leak their contents into the soft tissue beneath the s...
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Excessive bleeding
Infection (a slight risk any time the skin is broken)

Open References

References

Nikolic D. Spirochete infections. In: McPherson RA, Pincus MR, eds. Henry's Clinical Diagnosis and Management by Laboratory Methods. 24th ed. Philadelphia, PA: Elsevier; 2022:chap 61.

Steere AC, Lemieux JE. Lyme disease (Lyme borreliosis) due to Borrelia burgdorferi. In: Blaser MJ, Cohen JI, Holland SM, et al, eds. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. 10th ed. Philadelphia, PA: Elsevier; 2026:chap 247.

Wormser GP. Lyme disease. In: Goldman L, Cooney KA, eds. Goldman-Cecil Medicine. 27th ed. Philadelphia, PA: Elsevier; 2024:chap 296.

Blood test - illustration
Blood is drawn from a vein (venipuncture), usually from the inside of the elbow or the back of the hand. A needle is inserted into the vein, and the blood is collected in an air-tight vial or a syringe. Preparation may vary depending on the specific test.
Blood test
illustration
Lyme disease organism, Borrelia burgdorferi - illustration
Borrelia burgdorferi is a spirochete bacteria that causes Lyme disease. It is similar in shape to the spirochetes that cause other diseases, such as relapsing fever and syphilis. (Image courtesy of the Centers for Disease Control and Prevention.)
Lyme disease organism, Borrelia burgdorferi
illustration
Deer ticks - illustration
Diseases are often carried by ticks, including Rocky Mountain Spotted Fever, Colorado Tick Fever, Lyme disease, and tularemia. Less common or less frequent diseases include typhus, Q-fever, relapsing fever, viral encephalitis, hemorrhagic fever, and babesiosis.
Deer ticks
illustration
Ticks - illustration
There are many species of ticks. Of these, a large proportion are capable of carrying disease. Diseases carried by ticks include Lyme disease, Ehrlichiosis, Rocky Mountain Spotted Fever, Colorado Tick Fever, tularemia, typhus, hemorrhagic fever, and viral encephalitis. (Image courtesy of the Centers for Disease Control and Prevention.)
Ticks
illustration
Lyme disease - Borrelia burgdorferi organism - illustration
Lyme disease is caused when a person is bitten by a tick infected with bacteria called Borrelia burgdorferi. These bacteria are known as spirochetes because of their long, corkscrew shape. This photograph shows the typical corkscrew appearance of a spirochete. Other types of spirochete bacteria cause diseases such as syphilis and leptospirosis. After a person is bitten by an infected tick, the bacteria spread from the skin through the bloodstream to other organs. The skin, nervous system, joints, heart, and eyes are most often affected. (Image courtesy of the Centers for Disease Control and Prevention.)
Lyme disease - Borrelia burgdorferi organism
illustration
Tick imbedded in the skin - illustration
This is a close-up photograph of a tick embedded in the skin. Ticks are important because they can carry diseases such as Rocky Mountain spotted fever, tularemia, Colorado tick fever, Lyme disease, and others.
Tick imbedded in the skin
illustration
Antibodies - illustration
Antigens are large molecules (usually proteins) on the surface of cells, viruses, fungi, bacteria, and some non-living substances such as toxins, chemicals, drugs, and foreign particles. The immune system recognizes antigens and produces antibodies that destroy substances containing antigens.
Antibodies
illustration

Blood test - illustration
Blood is drawn from a vein (venipuncture), usually from the inside of the elbow or the back of the hand. A needle is inserted into the vein, and the blood is collected in an air-tight vial or a syringe. Preparation may vary depending on the specific test.
Blood test
illustration
Lyme disease organism, Borrelia burgdorferi - illustration
Borrelia burgdorferi is a spirochete bacteria that causes Lyme disease. It is similar in shape to the spirochetes that cause other diseases, such as relapsing fever and syphilis. (Image courtesy of the Centers for Disease Control and Prevention.)
Lyme disease organism, Borrelia burgdorferi
illustration
Deer ticks - illustration
Diseases are often carried by ticks, including Rocky Mountain Spotted Fever, Colorado Tick Fever, Lyme disease, and tularemia. Less common or less frequent diseases include typhus, Q-fever, relapsing fever, viral encephalitis, hemorrhagic fever, and babesiosis.
Deer ticks
illustration
Ticks - illustration
There are many species of ticks. Of these, a large proportion are capable of carrying disease. Diseases carried by ticks include Lyme disease, Ehrlichiosis, Rocky Mountain Spotted Fever, Colorado Tick Fever, tularemia, typhus, hemorrhagic fever, and viral encephalitis. (Image courtesy of the Centers for Disease Control and Prevention.)
Ticks
illustration
Lyme disease - Borrelia burgdorferi organism - illustration
Lyme disease is caused when a person is bitten by a tick infected with bacteria called Borrelia burgdorferi. These bacteria are known as spirochetes because of their long, corkscrew shape. This photograph shows the typical corkscrew appearance of a spirochete. Other types of spirochete bacteria cause diseases such as syphilis and leptospirosis. After a person is bitten by an infected tick, the bacteria spread from the skin through the bloodstream to other organs. The skin, nervous system, joints, heart, and eyes are most often affected. (Image courtesy of the Centers for Disease Control and Prevention.)
Lyme disease - Borrelia burgdorferi organism
illustration
Tick imbedded in the skin - illustration
This is a close-up photograph of a tick embedded in the skin. Ticks are important because they can carry diseases such as Rocky Mountain spotted fever, tularemia, Colorado tick fever, Lyme disease, and others.
Tick imbedded in the skin
illustration
Antibodies - illustration
Antigens are large molecules (usually proteins) on the surface of cells, viruses, fungi, bacteria, and some non-living substances such as toxins, chemicals, drugs, and foreign particles. The immune system recognizes antigens and produces antibodies that destroy substances containing antigens.
Antibodies
illustration

A Closer Look

Talking to your MD

Self Care

Tests for Lyme disease blood test

Review Date: 12/13/2025

Reviewed By: Jatin M. Vyas, MD, PhD, Roy and Diana Vagelos Professor in Medicine, Columbia University Vagelos College of Physicians and Surgeons, Division of Infectious Diseases, Department of Medicine, New York, NY. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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Health Library

Lyme disease blood test

Lyme disease

How the Test is Performed

Blood sample

ELISA test

How to Prepare for the Test

How the Test will Feel

Why the Test is Performed

Normal Results

What Abnormal Results Mean

Rheumatoid arthritis

Risks

Lightheaded

Hematoma

References

Blood test - illustration

Blood test

Lyme disease organism, Borrelia burgdorferi - illustration

Lyme disease organism, Borrelia burgdorferi

Deer ticks - illustration

Deer ticks

Ticks - illustration

Ticks

Lyme disease - Borrelia burgdorferi organism - illustration

Lyme disease - Borrelia burgdorferi organism

Tick imbedded in the skin - illustration

Tick imbedded in the skin

Antibodies - illustration

Antibodies