EBV TESTING
Updated: 19 hours ago
Many of us with Lyme also deal with viruses that have become active again after resting quietly in the body. Epstein-Barr virus (EBV), which most people carry by adulthood, is one of them. This post covers which EBV blood tests to ask for and what each result may mean, so you can go over them with your doctor.
Short on time or energy? A quick-view graphic with the key points is at the bottom of this post.
Looking for ideas that may help? See the solutions post:
EBV AND VIRAL - POSSIBLE SOLUTIONS
For more education on EBV and HHV-6 reactivation:
EBV (EPSTEIN-BARR VIRUS) AND HHV-6 REACTIVATED
WHY EBV TESTING COMES UP WITH LYME
- ILADS notes that people who have been sick with Lyme for a long time may also have other infections, such as EBV, CMV and HHV-6. ILADS adds that how these infections interact with Lyme is not well understood yet.
- EBV is a herpes-family virus, also called human herpesvirus 4. After the first infection, it stays in the body for life in a resting (latent) state, and it can reactivate later.
Credit to Toni and the Epstein-Barr Virus Support Group for the testing information below.
How to Test for Epstein-Barr (Herpesvirus 4) and Interpret Results.
Required Labs-
4 panel EBV antibodies lab work
Viral Capsid Antigen (VCA) IgM
Early Antigen (EA) IgG
Viral Capsid Antigen (VCA) IgG
EBV Nuclear Antigen (EBNA) IgG
Please ensure that the Early Antigen (EA) IgG is included in the lab work. The EA is usually the most crucial test for an active diagnosis, but often overlooked. It's important to note that most labs now require it to be selected separately.
How to Determine if you are currently active:
Positive VCA IgM
Positive VCA IgM and Early Antigen IgG
Positive Early Antigen IgG
Interpretation for Each Test-
Positive VCA IgM indicates a current infection, typically a primary infection. However, in some cases, it may also indicate a reactivation.
Positive Early Antigen IgG represents the acute phase of primary infection or a reactivation. However, 20% of healthy people may have antibodies against EA for years so it is important to take symptoms into account.
Positive VCA IgG and EBNA IgG represent a "past" infection. These should remain positive for the rest of your life following your primary infection.
There is also the quantitative EBV PCR DNA test which detects genetic material of the virus in your sample. It can also be beneficial to establish testing history with this test especially for immunocompromised patients. It should not be done in place of the antibodies test but in addition.
MORE TO KNOW ABOUT THESE RESULTS
- In a small number of people, EBNA antibodies don't show up after their first infection (about 3 to 5 in 100 people, and about 10 to 20 in 100 people with weakened immune systems). So a negative EBNA doesn't always mean a new infection.
- A low positive PCR result can be hard to read, because it may not tell a resting virus apart from a new infection.
WHAT LYME-LITERATE DOCTORS SHARE
- In a 2024 published report of three of his patients, Dr. Richard Horowitz listed EBV antibody tests (VCA IgG and EBNA IgG) and EBV PCR among their lab results. In two of them, a positive VCA IgG and EBNA IgG with a negative PCR was described as a sign of past (prior) exposure to EBV.
- Another Lyme-literate doctor suggests testing for viruses like EBV when someone isn't getting better after 6 to 9 months of Lyme treatment. He explains that IgG antibodies are the immune system's memory and stay for life, so a positive IgG alone doesn't prove the virus is active. There's a theory that very high IgG levels mean a virus is active, but he notes the science behind that theory is very limited.
BEFORE YOU START
- Ask your doctor which tests are right for you, and go over your results together. Lab results are one piece of the picture and are read along with your symptoms and history.
RELATED POSTS
REACTIVATED VIRUSES
LAB TESTS ON VARIOUS TOPICS
IMMUNE SYSTEM EDUCATION
SOURCES
ILADS, Lyme Disease Basics for Providers (no date shown)
Dr. Richard Horowitz and colleagues, report of three cases, Microorganisms (2024)
Dr. Marty Ross, Chronic Viruses: A Brief Guide (2025)
Virological Markers in Epstein-Barr Virus-Associated Diseases, Viruses (2023)
ARUP Consult (University of Utah), Epstein-Barr Virus (updated 2025)
Disclaimer: Rise Above Lyme makes no claims about any possible benefit of using any product mentioned within this site. Always consult with your doctor before adding anything. The information shared is based on personal experience, years of accumulated researched resources from Lyme Literate doctors and polls conducted within Lyme groups from actual patient experience using these solution ideas.
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