Print Print
CKS is no longer commissioned by the National Institute for Health and Clinical Excellence (NICE). NICE remains committed to providing a replacement service for CKS and is currently reviewing its options. In the meantime, although CKS content is now not being maintained, it still remains relevant and will continue to be made available. CKS content was generated under a programme of topic creation and update. To check if the topic you are viewing is current or out of date, please refer to the topic publication details by clicking on the 'How up-to-date is this topic?' link in the left hand menu on individual topic pages.

Lyme disease - Management
What investigations should I do, and when?

  • For all people with suspected Lyme disease, consider seeking advice from a microbiologist, an infectious diseases specialist, or the Lyme Borreliosis Unit on the appropriateness, timing, and type of investigations.
  • Testing is not generally considered to be necessary for people with erythema migrans and a history of a tick bite or possible exposure to ticks, as this presentation is sufficient to make a clinical diagnosis of Lyme disease.
  • Testing in primary care can be considered for:
    • People with a rash suggestive of erythema migrans but without a history of a tick bite or possible exposure to ticks and no other clinical features of Lyme disease.
    • People with isolated, unilateral facial palsy (as seen with Bell's palsy) if it is thought that Lyme disease needs to be excluded because of a history of a tick bite or possible exposure to ticks.
  • For people with other types of neurological symptoms, or with rheumatological or cardiac symptoms, testing should usually only be carried out in primary care following specialist advice. Many such people will require hospital admission or urgent specialist assessment.
  • To test for Lyme disease, take a blood sample for antibodies to Borrelia burgdorferi.
    • If the result is negative and the sample was taken within 2 weeks of the onset of symptoms, repeat the test 2 weeks later.
    • If the initial result is borderline or positive (by enzyme immunoassay), the same sample will be retested by the laboratory, using immunoblot or Western blotting, to confirm the result.
      • The enzyme immunoassay has low specificity (a high false positive rate) and can be positive with other conditions (including glandular fever, syphilis, rheumatoid arthritis, other autoimmune conditions, and some neurological conditions).

© NHS Institute for Innovation and Improvement