Can Lyme disease testing detect antibodies from 10-20 years ago?
Yes, in some cases, Borrelia burgdorferi antibodies can be detected decades after the initial infection, even after successful treatment.
Antibody (serological) testing advantages and disadvantages in detecting Lyme infection
- IgG antibodies can persist long-term: Studies have shown that people who had Lyme disease can still test positive for B. burgdorferi-specific IgG antibodies 10, 20, even 30+ years later. These antibodies reflect prior exposure, not necessarily active infection.
- IgM antibodies usually fade: IgM, which is the “early responder,” tends to decline after months, but IgG can remain detectable for life in some individuals.
- Not a marker of active disease: A positive antibody test decades later doesn’t mean the person still has Lyme. It simply shows the immune system remembers past exposure. This is why serology testing alone can’t diagnose active or recurrent infection- symptoms and clinical history must be evaluated.
- Cross-reactivity can complicate results: Some antibodies may react with other bacteria, making interpretation less straightforward in people with a remote history of Lyme.
Polymerase chain reaction (PCR) testing advantages and disadvantages in detecting detect Lyme infection
- PCR testing advantages: PCR tests detects the genetic material of B. burgdorferi directly, suggesting evidence of active infection when positive.
- PCR testing disadvantages: Studies show persistence of non-viable DNA fragments. After successful antibiotic treatment, PCR may still detect bacterial DNA for weeks to months. This means PCR testing cannot distinguish live vs. dead B. burgdorferi organisms. A positive result doesn’t always indicate an active infection — it may reflect “genetic debris” from cleared bacteria.
Key points:
- Because antibody testing and PCR each have strengths and limitations on their own, combining them gives a clearer picture.
- The Vibrant Tickborne Complete 2.0 Panel combines antibody testing with PCR testing and also tests for the presence of co-infections that may occur with Lyme (e.g., babesiosis, anaplasmosis, Bartonella infections).
- Lyme disease can have late complications (arthritis, carditis, neuropathy) that overlap with autoimmune or inflammatory conditions, blurring the clinical picture. The Vibrant Lyme Autoimmune Panel can help assess chronic Lyme-related immune dysfunction and its potential impact on autoimmunity.
Reference
Kalish RA, McHugh G, Granquist J, Shea B, Ruthazer R, Steere AC. Persistence of immunoglobulin M or immunoglobulin G antibody responses to Borrelia burgdorferi 10-20 years after active Lyme disease. Clin Infect Dis. 2001 Sep 15;33(6):780-5. doi: 10.1086/322669. Epub 2001 Aug 10. PMID: 11512082.