There are numerous Lyme disease tests on the market today. They vary considerably in terms of price, methodology, effectiveness, and ease of use. The addition of at-home Lyme disease tests have added more complexity to finding the Lyme disease test that is right for you.
Fundamentally, Lyme disease tests can be categorized into direct tests and indirect tests. Direct tests look for the bacteria or pathogen in a specimen. Indirect tests measure the immune system's response to being invaded by a pathogen. Both methods have their place, but the majority of testing methods today are indirect. Some of the indirect tests, such as ELISA and Western blot, have limitations and are no longer recommended, but other indirect tests such as ImmunoBlots are still considered the best. Direct tests become more important if a patient is immunosuppressed and doesn't make adequate antibodies. Adding a direct test such as PCR or Culture can be important because these direct tests are very specific. That is, if they detect the pathogen, there is a near certainty that you have Lyme disease. Unlike some older indirect tests, which can trigger false positives.
When choosing a Lyme disease test, it is also important to thoroughly understand what is being tested. For instance, many of the commercial laboratory tests and at-home tests detect antibodies to only one Lyme disease pathogen, B. burgdorferi B31. This reduces their accuracy dramatically. Newer recombinant antigen technology, which is used in AcuDart, Broad Coverage Assays, and ImmunoBlots detect antibodies to multiple pathogens. In the case of Lyme disease, nine different pathogens.
The chart below details the types of Lyme disease tests that are offered, their price, and whether they are recommended.