By Dr Nicola Ducharme
It can be confusing and overwhelming to know what the most important tests are to choose for Lyme testing (what isn’t confusing about Lyme, right?!). I have used IGeneX testing for years and love them – so I want to help guide you to the best choices for your own testing if you have a doctor who will sign off on your lab requisition. There is also a newer lab called DNA Connexions that might be a good option to use along with IGeneX.
"My advice is to do as comprehensive testing as you can afford."
Some general comments about Lyme testing
Before we get to that, I want to just reiterate a few things about Lyme testing in general.
The first is that Lyme disease is not just about a single type of bacteria; it’s about a combination of bacteria and protozoa – referred to as “co-infections”. I have always believed that missing relevant co-infections is one of the big hindrances to getting appropriate treatment and therefore improvement in symptoms – so in choosing our testing we want to cover those too.
Secondly, the more types of tests you run, the more likely you are to find evidence of Lyme if it is there. Sometimes one test will come out negative while another for the same bacteria is positive. Ordering a couple of different test types helps to maximize those chances. I have no financial affiliation with IGeneX so have no reason to say that other than as a practitioner, (1) I want to get as accurate a diagnosis possible for my patient; and (2) the more information I can gather on my patients, the better I am able to help them.
Thirdly, remember that no Lyme test is 100% accurate. IGeneX in my view is the best we have, but Lyme disease diagnosis is part done via labs, part history, and part clinical presentation. A negative test does not always rule out Lyme disease.
Ok, now a couple of general points about testing itself. I just want you to have a basic understanding of what these tests are.
Tests for infections such as Borrelia are classified either as direct tests, or indirect tests. In short, a direct test is looking for the bug itself, while an indirect test is measuring immune response to a bug. Optimally we have a combination of direct and indirect tests, again, trying to optimize our results.
Remember we want to be as comprehensive as possible to try to catch the different strains of Borrelia, and the nasty co-infections and their particular strains.
Blood versus Urine
IGeneX offers both blood (whole blood and serum) and urine tests.
I tend to focus on the blood testing panels. The majority of tests run by IGeneX are blood tests. However, there may be a few instances where urine testing is advantageous:
- The urine dot blot may be used in early/acute infection where the immune system may not have had a chance to mount an antibody response yet;
- In children where a blood draw would be traumatic;
- In patients who have tested negative on the antibody tests, just to look a different way and see what shows.
In chronic Lyme, my understanding has always been that the Lyme dot blot urine test is best when provoked – meaning, a patient is given antibiotics prior to doing the collection to increase the “die off” of bugs, and hence the residues showing up in the urine. With such limited access to treatment in Australia, that “provocation” may simply not be a reality.
DNA Connexions offers only a urine test. It is a PCR test, which is a direct test – that means that there is no dependence on antibody response/ immune response to get a positive. If there are DNA in the sample, then it shows as positive. It needs to be provoked either with exercise or a deep tissue massage, and I’ve seen that make a big difference in test results (meaning that patients who haven’t done either of those things tend to come back with all negative results).
Two Main Options I recommend:
Option #1: IGeneX testing
So here’s my rough guide – first, let’s talk about doing all testing through IGeneX:
Level 1 - Basic:
LTP1 – Lyme/ TBRF panel 1
This panel provides IFA and Western blots for Borrelia burgdorferi and tick-borne relapsing fever (TBRF), but no co-infections. The IFA and Western blots are both indirect tests (ie measure antibody response).
For those who are brand new to the idea of Lyme, and want to do a preliminary screen without the expense of all the co-infections, this would be the panel to choose.
I definitely recommend doing both strains – the B. burgdorferi and TBRF – I have had patients in Australia test positive for TBRF and not “regular” Lyme disease (Bb), so with only the B. burgdorferi markers it would have been missed.
The cost of this panel is US$895.50.
Level 2 – Intermediate:
TBD1 – Tick-borne Disease Panel 1
This panel provides IFA and Western blots for Borrelia burgdorferi and tick-borne relapsing fever. Indirect tests only but it is good in that it covers both strains.
It offers indirect testing for co-infections – IFA and antibody tests (IgG and IgM) – for Babesia microti, Babesia duncani, HME, HMA and Bartonella.
This panel covers co-infections but still doesn’t offer any direct tests, ie PCR or FISH. However I feel it is still a good panel to cover a lot of co-infections while trying to balance costs somewhat.
The cost of this panel is US$1346.25.
Level 3 – Comprehensive:
For those who want to get the most comprehensive panels available – two strains of Borrelia, all co-infections, with both direct and indirect tests, that would be this combination –
LTP3 – Lyme/ TBRF Panel #3
Tests IFA and Western blots for Borrelia burgdorferi, PCR for Borrelia burgdorferi;
Western blots and PCR for TBRF.
CP3 – Co-infection Panel #3
Tests for all major co-infections – Babesia microti, Babesia duncani, HME, HMA and Bartonella.
Offers direct and indirect tests – antibody tests as well as PCR.
The cost of this combination is US$2327.75.
I feel that the intermediate version provides the best value for money, and still provides a thorough array of testing.
Option #2: Combination of IGeneX and DNA Connexions
This is an option that I’m choosing more frequently now, mostly to save some money for my patients. I have been testing the Borrelia strains through IGeneX with their Lyme/TBRF panel #1; then running the DNA Connexions panel for the co-infections.
The Lyme panel through DNA Connexions measures 17 different markers covering 11 different pathogens –
- Borrelia burgdorferi, Borrelia miyamotoi, Borrelia recurrentis
- Babesia microti, Babesia divergens, Babesia duncani
- Bartonella bacilliformis, Bartonella henselae, Bartonella quintanta
- Ehrlichia chaffensis and Anaplasma phagocytophilum
It is a urine collection, as I said, it does need to be provoked with either an hour of exercise (ironic, I know, that a test for Lyme asks one to exercise for an hour!) or a deep tissue massage for those who can’t exercise. I do think this provocation makes a big difference.
Kits can be ordered directly from DNA Connexions. There is a $25 kit deposit which is taken off the price of the test when the sample is sent in. You do not even need a doctor’s order to get that test done.
I’m liking the DNA Connexions testing for co-infections, and being a PCR test, if the bacteria or protozoa are identified in the sample, it pretty much means they’re in the body. I haven’t stopped using IGeneX – I would still run their Borrelia/TBRF panel to get the most information possible especially in an individual who hasn’t had any Lyme testing, or a positive diagnosis, yet. The DNA Connexions can also be handy in people who’ve had a lot of treatment to get a sense of what’s actually still active in their body.
I hope this is helpful for sorting out all the different testing options. There is a lot to figure out. My advice is to do as comprehensive testing as you can afford. But remember, IGeneX keeps all blood samples for three (3) months, so if you start with a Borrelia panel and want to add on co-infections later, they can do that on the same sample.