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Lyme Disease Antibody with Reflex to Immunoassay (IgG, IgM)
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Lyme Disease Antibody with Reflex to Immunoassay (IgG, IgM)
Quest DiagnosticsCatalog information reviewed: August 24, 2026 by the Sunridge Medical clinical team.
What this laboratory test evaluates
DetailsLyme Disease Antibody with Reflex to Immunoassay (IgG, IgM) – This test is for the qualitative detection of antibodies against Borrelia burgdorferi, the causative agent of Lyme disease, using the modified two-tier testing (MTTT) algorithm. Initial testing is performed using a Lyme total (IgG and IgM) antibody assay, and if positive or equivocal, the sample is then tested using separate IgG and IgM immunoassays. This algorithm differs from the STTT algorithm in that the second-tier assays are chemiluminescent immunoassays, not immunoblots. MTTT may be able to assist in the identification of Lyme disease with improved sensitivity earlier in infection compared to STTT.
Diagnostic testing for Lyme disease relies on a two-step algorithm to increase sensitivity and specificity. Testing is performed in patients presenting with signs and symptoms consistent with Lyme disease and with potential tick exposure in endemic regions. Most infections are transmitted by blacklegged ticks in the upper midwestern, northeastern, and mid-Atlantic states.
Negative results can occur in patients with recent infection (≤14 days). In persons with recent or past infection, both IgG and IgM can be detectable months to years after the infection has resolved. Therefore, it is recommended to interpret results in the context of the clinical picture, history, including exposure risk, and symptom onset.
References:
1. Mead, P. et al. Updated CDC Recommendation for Serologic Diagnosis of Lyme Disease. Wkly Rep. 2019 Aug 16;68(32):703. doi: 10.15585/mmwr.mm6832a4.
2. Suggested Reporting Language, Interpretation and Guidance For Lyme Disease Serologic Test Results. Association of Public Health Laboratories. April 2024.
3. Sfeir MM, Meece JK, Theel ES, et al. Multicenter clinical evaluation of modified two-tiered testing algorithms for Lyme disease using zeus scientific commercial assays. J Clin Microbiol 2022; 60:e0252821.
4. Tickborne Diseases of the United States. A Reference Manual for Healthcare Providers, Sixth Edition, 2022. Centers for Disease Control and Prevention.
What type of sample is required for this test?1 mL serum
Test ResourcesFor more information, please consult your healthcare provider.
Additional test information
Lyme Disease Antibody with Reflex to Immunoassay (IgG, IgM) – This test is for the qualitative detection of antibodies against Borrelia burgdorferi, the causative agent of Lyme disease, using the modified two-tier testing (MTTT) algorithm.
Collection and processing
- Sample type: Serum
- Fasting: No
- Estimated laboratory processing: Results should be available in 2 – 5 business days after the sample is collected
How Sunridge uses laboratory information
Sunridge considers the medical question, symptoms, history, medications, prior results, and whether the finding could change care before recommending testing. A laboratory result is not interpreted in isolation and does not establish a diagnosis by itself.
Before requesting this test
Availability, collection requirements, eligibility, and processing estimates can change. Sunridge reviews each request and, when appropriate, creates the order through Fullscript. Follow the current instructions supplied with the approved order.
Related Sunridge care
Learn how Sunridge approaches Lyme Disease and ask whether this test is appropriate for your clinical question.
Common questions about this laboratory test
- What sample does this test require?
- The listed sample type is Serum. Confirm current collection instructions in the approved order.
- Does this test require fasting?
- The current catalog record lists fasting as: No. Follow the instructions supplied with the approved order.
- How long does laboratory processing usually take?
- Results should be available in 2 – 5 business days after the sample is collected. Timing can change after collection or if a laboratory requires additional review.
About this test
DetailsLyme Disease Antibody with Reflex to Immunoassay (IgG, IgM) - This test is for the qualitative detection of antibodies against Borrelia burgdorferi, the causative agent of Lyme disease, using the modified two-tier testing (MTTT) algorithm. Initial testing is performed using a Lyme total (IgG and IgM) antibody assay, and if positive or equivocal, the sample is then tested using separate IgG and IgM immunoassays. This algorithm differs from the STTT algorithm in that the second-tier assays are chemiluminescent immunoassays, not immunoblots. MTTT may be able to assist in the identification of Lyme disease with improved sensitivity earlier in infection compared to STTT.
Diagnostic testing for Lyme disease relies on a two-step algorithm to increase sensitivity and specificity. Testing is performed in patients presenting with signs and symptoms consistent with Lyme disease and with potential tick exposure in endemic regions. Most infections are transmitted by blacklegged ticks in the upper midwestern, northeastern, and mid-Atlantic states.
Negative results can occur in patients with recent infection (≤14 days). In persons with recent or past infection, both IgG and IgM can be detectable months to years after the infection has resolved. Therefore, it is recommended to interpret results in the context of the clinical picture, history, including exposure risk, and symptom onset.
References:
1. Mead, P. et al. Updated CDC Recommendation for Serologic Diagnosis of Lyme Disease. Wkly Rep. 2019 Aug 16;68(32):703. doi: 10.15585/mmwr.mm6832a4.
2. Suggested Reporting Language, Interpretation and Guidance For Lyme Disease Serologic Test Results. Association of Public Health Laboratories. April 2024.
3. Sfeir MM, Meece JK, Theel ES, et al. Multicenter clinical evaluation of modified two-tiered testing algorithms for Lyme disease using zeus scientific commercial assays. J Clin Microbiol 2022; 60:e0252821.
4. Tickborne Diseases of the United States. A Reference Manual for Healthcare Providers, Sixth Edition, 2022. Centers for Disease Control and Prevention.
What type of sample is required for this test?1 mL serum
Test ResourcesFor more information, please consult your healthcare provider.
Additional details
Lyme Disease Antibody with Reflex to Immunoassay (IgG, IgM) - This test is for the qualitative detection of antibodies against Borrelia burgdorferi, the causative agent of Lyme disease, using the modified two-tier testing (MTTT) algorithm.
Highlighted health areas
- Infectious Disease
- Lyme & tick-borne disease
Biomarkers and report focus
The exact analytes and report format can change. Confirm the current contents in the Fullscript order before payment.
- Borrelia burgdorferi IgG+IgM
- Lyme Ab (IgG)
- Lyme Ab (IgM)