Labs and Testing
Like other aspects of Lyme disease, laboratory testing is complex and controversial. The stealth nature of the Lyme-causing pathogen Borrelia means that it has ways of avoiding detection by the immune system. Along with dysfunctional immune systems in patients, this contributes to the challenges experienced with Lyme testing.
False negatives are common in serology (blood serum and other bodily fluids) tests, so multiple tests may be required to gain certainty of Lyme-positive pathology.
At this point in time, there is no sole universal test that is 100% reliable and uniformly used globally.
We can refer you to a lab or Lyme-literate practitioner for assistance with testing, diagnosis and treatment. Please get in touch.
Testing in Australia
Health policy in Australia complicates the issue further. Currently, a positive lab test is required for a Lyme diagnosis. However, lab tests can only be ordered by infectious disease specialists or microbiologists and will only be requested if the patient has travelled overseas.
Yes, this is confusing and frustrating. Working within the mainstream medical system in Australia, a patient will almost never receive a diagnosis of Lyme disease, regardless of test results (even if they present Lyme-positive tests from overseas labs), if they have not travelled overseas.
If you have travelled overseas, your GP should refer you to a microbiologist or infectious diseases specialist. If the specialist has a long waiting list, a patient’s treatment may be delayed. Acute Lyme disease requires urgent treatment.
If you have not travelled overseas, your options are:
- Find a Lyme-literate practitioner in Australia to assist with testing
- Order tests privately
- Travel overseas for diagnosis and/or medical assistance.
Cost of Testing
- The cost of Lyme and associated disease testing, which ranges from hundreds to several thousand dollars, is generally not covered under Medicare in Australia.
- Lyme patients are usually infected with other pathogens, for example, Rickettsia, Bartonella, Babesia and/or viruses, so multiple tests may be required (which can increase costs).
Overseas labs such as IgeneX, ArminLabs and DNA ConneXions are commonly used by Australian patients and Lyme-literate doctors. Your Lyme-aware practitioner may have pathology request forms, or on request, labs will send a test kit directly to the patient. Kits include vials and collection instructions, and the bloods/fluids are posted by the patient to the lab.
- ArminLabs is located in Germany, and patients will usually speak with an MD and/or complete a questionnaire rather than require a medical referral.
- IgeneX and DNA ConneXions are located in the US. While you may order their kits online, these labs require medical referrals.
- Vibrant America is also located in the US. This option is recommended if you are planning on getting SOT (Supportive Oligonucleotide Therapy). They use dry blood samples.
- Aust Bio Testing (Australian Biologics) is the only Australian lab that does not require a medical referral. They are TGA approved but are still working towards NATA accreditation (see below).
NB. All of the above laboratories are not National Association of Testing Authorities, Australia (NATA) accredited. Most overseas labs are not NATA accredited, and hence tests from these labs will not be recognised by Australian GPs and infectious disease specialists (with the exception of Lyme-literate practitioners).
* Results from any overseas lab that is a signatory to the ILAC MRA agreement (an international agreement regarding laboratory standard equivalency) should be recognised, but Australian health authorities refuse to do so, insisting on NATA accreditation, which is unnecessary for ILAC MRA signatory labs.
- Australian Rickettsial Reference Laboratory (ARRL) is another Australian lab sometimes used, but it requires a medical referral. This lab may offer Medicare rebates. NATA accredited.
Which Lab? Which Tests?
Ideally, the decisions as to which lab, and which tests to order would be made jointly between patient and practitioner, taking into consideration both budget, likely co-infections and clinical history.
The LDAA does not recommend ‘two-tiered’ testing (see next section).
For more information on the different types of tests, for example ELISA, FSH, PCR, Western Blot, Elispot, Immunoblot, etc, take a look at the following articles (and the More Information section below):
- A Review of Lyme Infection Tests: Pass or Fail by Dr Marty Ross
- The Best Lab & Test for Borrelia, Bartonella, & Babesia by Dr Marty Ross
- Article: An Overview of Lyme Disease Testing by Dr Todd Maderis
International Testing Standards
According to the International Lyme and Associated Diseases Society (ILADS), international best practice for diagnosis is a clinical diagnosis (a doctor’s interpretation of symptoms and history), not necessarily requiring pathology, but this is not yet universally accepted.
The US Centre for Disease Control (CDC) requires 2 tier testing, as do many other countries’ health authorities, including Australia. The first test of the two, usually an ELISA, is known to have a high level of false results. This means that many Lyme-positive patients are dismissed by their practitioners due to having tested negative, despite suffering a variety of typical Lyme symptoms and obviously needing further testing to confirm a diagnosis.
ILADS has concluded that the two-tiered test strategy does not adequately serve the clinician or patient. The LDAA endorses ILADS recommended testing.
The LDAA is lobbying for Australia to adopt international best practices regarding Lyme testing and diagnosis.
- Video: Lyme Disease Testing: Why Tests & Doctors Miss the Mark with Nicole Bell, author and Galaxy Diagnostics laboratory employee
- Video: Conversations with Marty Ross MD: 7/12/23
- Video: Understanding Diagnosis and Testing LDAA interview with Prof Adj Leona Gilbert, 2022
- Video: IGeneX – Which Test? LDAA interview with Dr Steven Harris, 2022
- Video: Lyme Testing and Interpretation with Dr Nicola Ducharme
- Study: Anderson C, Brissette CA. The Brilliance of Borrelia: Mechanisms of Host Immune Evasion by Lyme Disease-Causing Spirochetes. Pathogens. 2021