The Past, Present, and (Possible) Future of Serologic Testing for Lyme Disease

J Clin Microbiol. 2016 May;54(5):1191-6. doi: 10.1128/JCM.03394-15. Epub 2016 Feb 10.


Lyme disease prevails as the most commonly transmitted tick-borne infection in the United States, and serologic evaluation for antibodies to Borrelia burgdorferi remains the recommended modality for diagnosis. This review presents a brief historical perspective on the evolution of serologic assays for Lyme disease and provides a summary of the performance characteristics for the currently recommended two-tiered testing algorithm (TTTA). Additionally, a recently proposed alternative to the traditional TTTA is discussed, and novel methodologies, including immuno-PCR and metabolic profiling for Lyme disease, are outlined.

Publication types

  • Historical Article
  • Review

MeSH terms

  • Algorithms
  • Antibodies, Bacterial / blood*
  • Borrelia burgdorferi / genetics
  • Borrelia burgdorferi / immunology*
  • Borrelia burgdorferi / metabolism
  • History, 20th Century
  • History, 21st Century
  • Humans
  • Lyme Disease / diagnosis*
  • Metabolomics / methods
  • Polymerase Chain Reaction / methods
  • Serologic Tests / history*
  • Serologic Tests / trends*
  • United States


  • Antibodies, Bacterial