LYME DISEASE AND CO-INFECTION TESTING
Updated: Oct 19
Lyme and co-infection testing keeps changing. A great way to stay informed is to follow ILADS and IGeneX, since both share testing education and updates:
Before anything else, I'd love for you to look at these two:
There is a quick-view graphic with the key points at the bottom of this post.
LET YOUR LYME LITERATE DOCTOR GUIDE YOUR TESTING
It is best to have a Lyme literate doctor order the tests they feel are right for you. Every Lyme literate doctor has their own favorite labs and their own way of testing, and that's okay. I lean on what my own Lyme doctors use and trust.
LYME IS A CLINICAL DIAGNOSIS
Remember, Lyme is a clinical diagnosis. Your doctor looks at your history, your symptoms and your chance of tick exposure. ILADS (the International Lyme and Associated Diseases Society) teaches that test results can help back up a Lyme diagnosis, but they can't decide it either way on their own.
A few things ILADS shares that help explain why:
- Fewer than 30% of people with Lyme in the US remember a tick bite.
- Fewer than 20% of Lyme rashes look like the classic bull's-eye.
- The standard two-step testing (ELISA first, then Western blot only if the ELISA is positive) misses many infections.
- Some people never test positive for antibodies, even when tested more than once.
- Co-infections like Babesia, Bartonella, Anaplasma and Ehrlichia should be considered too, and testing for them can be tricky.
Research from Johns Hopkins, shared by LymeDisease.org, adds that many people who clearly have Lyme don't make a measurable antibody response at all, which is one more reason antibody tests can miss it.
Testing is used to confirm a diagnosis your doctor has already made based on how you present.
WHAT'S NEW IN LYME TESTING (2026)
- April 2026: A study supported by the Bay Area Lyme Foundation and published in the Journal of Clinical Microbiology found that common FDA-cleared two-tier tests missed 64% to 78% of early Lyme cases. These tests look for antibodies instead of the bacteria itself, and antibodies may not show up in the first week or two.
- July 2026: LymeDisease.org shared a study in Microbiology Spectrum on IGeneX's FDA-cleared single-step Lyme ImmunoBlots. They picked up 58.3% of early Lyme cases, compared with 30.0% for standard two-tier testing. The IGeneX tests use antigens from several Borrelia species and strains found in the US and Europe.
- IGeneX's Lyme IgG ImmunoBlot (the iDart Lyme IgG ImmunoBlot Kit) was FDA cleared in 2024. It has 31 Lyme antigen bands and includes OspA (P31) and OspB (P34).
- November 2025: In a Bay Area Lyme Foundation interview, IGeneX's lab director, Dr. Jyotsna Shah, shared that IGeneX's testing finds more positive patients than standard two-tier testing, and that its newly FDA-cleared ImmunoBlot covers several Borrelia species. Patient samples from Bay Area Lyme's Lyme Disease Biobank helped make these advances possible.
- June 2026: Bay Area Lyme Ventures, the Bay Area Lyme Foundation's investment fund, invested in Galaxy Diagnostics to help grow its research and expand access to its testing for Lyme and related infections.
- LymeSeek began with Monica Embers's research at Tulane University and is being developed by ACES Diagnostics. A Journal of Clinical Microbiology study, shared by LymeDisease.org in October 2026, reported 90% sensitivity and 93% specificity. It is not FDA cleared or available yet. Clinical trials are set to begin in October 2026, with a goal of reaching the market in early 2027.
WHAT TRUSTED LYME DOCTORS SHARE ABOUT TESTING
Dr. Richard Horowitz:
- He uses the IGeneX IgM and IgG Lyme ImmunoBlot as his first-line test.
- For Babesia and Bartonella he uses a combination of antibody tests, PCR and FISH (a test that looks for the germ directly).
- He shares that local PCR only catches infection about 10% of the time, so he prefers several samples through specialty labs.
- He believes one negative test doesn't rule out infection and uses a panel of tests, with the diagnosis based mainly on symptoms.
Dr. Marty Ross (updated 2026):
- He recommends IGeneX ImmunoBlots, both IgM and IgG, for Lyme, Bartonella and Babesia, no matter how long you have been sick.
- IGeneX test numbers he lists: Lyme 325 (IgM) and 335 (IgG), Bartonella 374 (IgM) and 384 (IgG), Babesia 900 (IgM) and 905 (IgG).
Dr. Joseph Burrascano (IGeneX testing presentation, January 2026):
- For Lyme, he describes the IGeneX Lyme ImmunoBlot, with IgM and IgG reported separately.
- For Babesia and Bartonella, he pairs the ImmunoBlot with FISH, and may add culture-enhanced PCR in harder cases.
- He suggests thinking about tick-borne relapsing fever (TBRF) when Lyme tests are negative or borderline, since it can look just like Lyme.
- He notes that no single test catches every Babesia or Bartonella infection, so using more than one kind of test helps.
- Bartonella tests may need repeating, since they can turn positive after some treatment.
MY NOTES ON TESTING FOR "THE BIG 3"
Testing for Lyme, Bartonella and Babesia (the "Big 3") is complicated and not perfect. I want to give you the best info possible so you can make wise choices, but I would trust your Lyme literate doctor on what they feel is best for you.
The Lyme literate doctors I trust most often prefer IGeneX and Galaxy Diagnostics for the Big 3. No test gets it right 100% of the time, but these labs give you better odds of accurate testing.
Babesia: IGeneX is the lab most mentioned. They pair antibody testing with FISH, which looks for the parasite itself. You can watch IGeneX webinars by Lyme doctors here:
Bartonella: Galaxy Diagnostics is the lab most mentioned, especially their digital PCR testing. Bartonella is very hard to catch on testing, which is why more than one blood draw is often recommended. Unfortunately this testing can be expensive and out of reach for many patients. If that is your situation and your regular lab is negative for Bartonella, you will want to be evaluated by a Lyme literate practitioner who knows how to diagnose Bartonella by very specific symptoms instead.
If you are new to Lyme and not yet diagnosed: Maybe you suddenly got sick with flu-like symptoms a few months ago and keep getting worse, or maybe you've been sick a long time and nothing else can be found. This is a good time to test. The IGeneX ImmunoBlot is the test most mentioned in this situation, and it can help your doctor confirm Lyme if you fit the clinical picture.
If you have already been diagnosed and treated: The immunoblot is less helpful, and your doctor most likely won't repeat it. I was taught that an antibody test can never tell you that you are actively infected, only that at some point you were exposed. Dr. Horowitz also notes that antibodies can stay positive for months or even years.
Looking for active infection: Tests that look for the germ itself, such as PCR, FISH or Galaxy's Nanotrap urine test, are used to look for active infection. A positive result is helpful, but a negative one does not rule infection out.
STANDARD LABS (LABCORP, QUEST)
I was taught that as a new patient, you can always start testing Lyme and its co-infections with whichever lab your insurance covers. I was also taught that standard labs like LabCorp and Quest are fine for many things connected to Lyme, and that they do find Lyme, Babesia and Bartonella in a small percentage of cases. Keep in mind that ILADS says the standard two-step testing misses many infections.
If the Big 3 come back negative, though, never trust that result. Move on to an evaluation by a Lyme literate practitioner with testing from a specialty lab, preferably IGeneX and Galaxy. I REPEAT, DO NOT MOVE ON AND ASSUME YOU ARE IN THE CLEAR.
OTHER LABS YOU MAY HEAR ABOUT
Vibrant has become popular with patients because a lot can be tested with one blood draw. As with any testing for Lyme, Babesia and Bartonella, a negative result does not mean you don't have these infections. Dr. Marty Ross has shared that he does not use Vibrant because of the false positives he sees in his patients, so please talk with your doctor about which lab is right for you.
Other labs you may have heard of are Stony Brook in New York, ArminLabs in Germany and MDL. Sometimes insurance will cover tests from these labs, so check your own coverage.
INSURANCE AND MEDICARE
I was taught that with IGeneX and Galaxy Diagnostics, you can sometimes get reimbursed by your insurance company if you pay for the test first and then submit a claim.
For Medicare, see my post here:
HOW TO TEST WITH IGENEX
- Order a test kit from the IGeneX website. There is a small deposit that goes toward your testing.
- When it comes, take the test requisition form in the kit to your doctor to fill out and sign with you.
- I was taught that if your doctor will not sign, you can ask another practitioner you see, like your naturopath, chiropractor or dentist, if they are able to sign in your state. I often tell them I do not need them to interpret the results, so the pressure is off them.
- If you are using Medicare, see my Medicare post above first.
OTHER CO-INFECTIONS
I was taught that other co-infections can usually be tested by whichever lab your insurance pays for, and that standard labs are generally pretty accurate for everything except Lyme, Bartonella and Babesia. For example, LabCorp picked up my Rocky Mountain spotted fever. ILADS notes that testing for co-infections can be challenging and results can vary, so your doctor's judgment still matters. These include:
- Anaplasma
- Brucella
- Chlamydia pneumoniae
- EBV
- Ehrlichia
- Mycoplasma pneumoniae
- Rickettsia, including Rocky Mountain spotted fever
- Toxoplasmosis
- Tularemia
ILADS also notes that people who have been sick a long time may have other infections, like EBV, CMV, HHV-6 and Mycoplasma, that are worth checking. Dr. Horowitz adds that low white blood cell or platelet counts, or high liver enzymes on basic blood work, can be early clues of a tick-borne infection.
MOLD
Mold should be ruled out too. Ask your doctor which mold test is right for you. My mold post has more:
AT-HOME TESTING
AcuDart Health sells at-home screening tests for Lyme, tick-borne relapsing fever (TBRF), Babesia and Bartonella, plus a panel for all four. I don't have much feedback on these yet, and they were showing out of stock when I checked in October 2026.
HELPFUL VIDEOS
Understanding Lyme results
Lyme testing isn't always accurate
RELATED POSTS FOR FULL UNDERSTANDING
IgG vs IgM
Lyme Bands Explained
Band 41
Lab Tests on Various Topics
Tick Testing
Average Time for Diagnosis
Dismissive Doctors
Fibromyalgia
MS, ALS, Dementia and Parkinson's
Chronic Fatigue Syndrome (CFS/ME)
SOURCES
ILADS - Lyme Disease Basics for Providers (updated 2026)
Bay Area Lyme Foundation - Common FDA-cleared Lyme tests miss 64-78% of early cases (April 2026)
LymeDisease.org - IGeneX FDA-cleared Lyme test aimed at earlier diagnosis (July 2026)
LymeDisease.org - New data on LymeSeek (October 2026)
LymeDisease.org - LymeSeek and Tulane research (2024)
LymeDisease.org - Why many Lyme patients don't make antibodies (Johns Hopkins research)
IGeneX - Lyme ImmunoBlot receives FDA clearance (2024)
IGeneX - Understanding Tick-Borne Disease Testing in 2026, presented by Dr. Joseph Burrascano (January 2026)
Bay Area Lyme Foundation - Better Tests, Better Answers (November 2025)
Bay Area Lyme Foundation - Bay Area Lyme Ventures invests in Galaxy Diagnostics (June 2026)
IGeneX
Galaxy Diagnostics
Dr. Richard Horowitz, Let's Talk About Testing for Lyme Disease (2024)
Dr. Marty Ross, The Best Lab and Test for Borrelia, Bartonella and Babesia (updated 2026)
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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