A primer
About Lyme disease.
A spirochete called Borrelia burgdorferi (and its relatives) is delivered by an Ixodes tick. What follows can be a clean, treatable infection — or a years-long medical detective story. The difference often comes down to testing.
The three stages, briefly.
Early localised Lyme appears days to a few weeks after the bite. The classic erythema migrans rash shows in only a portion of patients — and never in many. Flu-like symptoms are common; antibodies are usually not yet detectable.
Early disseminated disease arrives within weeks. Multiple rashes, cranial nerve palsies, carditis, and migrating joint pain are possible. Antibody tests start to become useful here, though they still miss a meaningful share of patients.
Late disseminated Lyme can show months or years later as arthritis, neurological symptoms, or a more diffuse constellation that gets labelled chronic. Standard serology is least helpful when patients need answers most.
Why testing is so contested.
Most Lyme tests measure antibodies, not the organism. Antibody tests depend on a competent, timely immune response — and Borrelia is extraordinarily good at evading or distracting that response. False negatives are common in early disease and in patients with chronic infection. False positives happen with related infections and autoimmune conditions.
Direct tests like DualDur — look for Borrelia itself. They are harder to run, slower, and more expensive. They are also, when positive, much more definitive. Secondary marker tests, such as PCR and antibodies, are less expensive, and indeed less accurate.
How to use this site.
Start with the tests catalogue. Each dossier explains what the test detects, how it's done, where it's strong, and where it fails. If you're working with a Lyme-literate clinician, these pages are meant as a shared reference, not a substitute for their judgement.
And if you're a patient who has been told "your Lyme test was negative" while still feeling unwell — read the indirect testing section first. A negative ELISA is far from the end of the story.