Your Lyme Test Is Positive—Now What?
A Clear, Step-by-Step Guide to What to Do Next
By Dr. Chad Rechcygl, DC
A positive Lyme disease test can bring relief because you may finally have an explanation for how you feel. It can also create fear and confusion.
Take a breath. A positive test deserves prompt attention, but it does not mean you should panic or begin treating yourself. The next step is to determine what the result actually means in the context of your symptoms, exposure history, previous infections, and the type of test that was performed.
The short answer: Contact the clinician who ordered the test, confirm that the result meets the recommended two-step testing criteria, review your symptoms and timeline, and discuss whether treatment is appropriate. Seek urgent care immediately if you have heart, neurologic, or other severe symptoms.
Taking dominion over your health begins with clarity and wise action.
Step 1: Confirm What “Positive” Actually Means
Most Lyme blood tests do not detect the bacteria directly. They detect antibodies your immune system has made in response to *Borrelia burgdorferi*, the primary bacterium that causes Lyme disease in the United States.
The CDC recommends a two-step blood-testing process (https://www.cdc.gov/lyme/hcp/diagnosis-testing/index.html):
1. A screening antibody test is performed first.
2. If that test is positive or equivocal, a second test is performed.
3. The overall result is considered positive only when the two-step algorithm meets the required criteria.
A positive screening test by itself is not the same as a confirmed positive result.
Ask your clinician:
- Was my result based on the complete two-step testing process?
- Was the second test an immunoblot or a second FDA-cleared enzyme immunoassay?
- Was the result IgM-positive, IgG-positive, or both?
- When did my symptoms begin?
- Have I previously had or been treated for Lyme disease?
Need to get tested?
Lyme Disease Antibodies (IgG, IgM), Immunoblot
This test checks for Lyme disease, which is spread by ticks carrying Borrelia burgdorferi. It uses a method called Immunoblot to look for specific antibodies in the blood with high accuracy. This is usually done to confirm results from other tests like EIA or IFA.
Biomarkers
Borrelia burgdorferi IgG
Borrelia burgdorferi IgM
Lyme IgG Band 18
Lyme IgG Band 23
Lyme IgG Band 28
Lyme IgG Band 30
Lyme IgG Band 39
Lyme IgG Band 41
Lyme IgG Band 45
Lyme IgG Band 58
Lyme IgG Band 66
Lyme IgG Band 93
Lyme IgM Band 23
Lyme IgM Band 39
Lyme IgM Band 41
Why the Timing Matters
Antibodies can take several weeks to develop, so testing may be negative early in an infection. On the other hand, Lyme antibodies can remain detectable for months or years after the infection is gone. This means a positive result cannot, by itself, tell you when you were infected, whether the infection is still active, or whether treatment worked.
The CDC also advises that an IgM-only positive result should generally be disregarded when symptoms have been present for more than 30 days. False-positive reactions can occur with conditions such as Epstein-Barr virus infection, rheumatoid arthritis, syphilis, and relapsing fever.
Here is the practical way to think about the result:
Test situation | What it may mean | Best next step |
Positive two-step test plus compatible recent symptoms | Current Lyme disease may be likely | Prompt medical evaluation and treatment discussion |
Positive result with a previous Lyme infection | Antibodies may reflect the old infection | Compare new symptoms, exposure, and exam findings |
IgM-only positive after more than 30 days of symptoms | Greater chance of an inaccurate interpretation | Ask the clinician to reassess the result |
Positive test without symptoms or a credible exposure | Past exposure or a false-positive result is possible | Do not assume active disease; review with a qualified clinician |
Classic expanding Lyme rash after likely tick exposure | Lyme may be diagnosed clinically even if early blood work is negative | Seek prompt treatment rather than waiting for another test |
Step 2: Check for Symptoms That Need Immediate Care
Lyme disease can sometimes affect the heart or nervous system. Do not wait for a routine appointment if you develop:
- Chest pain, fainting, significant shortness of breath, or a new rapid, slow, or irregular heartbeat
- A new facial droop, especially when accompanied by arm weakness, speech difficulty, confusion, or loss of balance
- A severe headache with fever, a stiff neck, marked light sensitivity, confusion, or weakness
- New or rapidly worsening numbness, shooting nerve pain, or loss of strength
- Severe illness, dehydration, or symptoms that are worsening quickly
Call 911 for possible stroke symptoms, severe chest pain, fainting, or difficulty breathing. Lyme-related heart rhythm problems can change rapidly, and new neurologic symptoms may have causes other than Lyme that also require immediate evaluation. The [CDC lists facial paralysis, irregular heartbeat, severe headache, neurologic symptoms, and arthritis among possible later manifestations](https://www.cdc.gov/lyme/signs-symptoms/index.html).
If you are pregnant, immunocompromised, or evaluating a young child, contact the appropriate medical clinician promptly so testing and treatment can be individualized.
Step 3: Prepare for Your Medical Appointment
Bring the complete laboratory report—not just a message that says “positive.” Then write down:
- When each symptom began
- Whether you saw a tick or remember a bite
- Where and when you may have been exposed
- Whether you developed an expanding rash; include dated photos if possible
- Any fever, chills, headache, fatigue, muscle pain, joint pain, facial weakness, numbness, palpitations, dizziness, or shortness of breath
- Any previous Lyme diagnosis or treatment
- Current prescriptions, supplements, medication allergies, pregnancy status, and major health conditions
This history matters because Lyme disease is not diagnosed by a laboratory result alone. A clinician should interpret the test alongside your symptoms, physical findings, exposure risk, location, and timing.
Step 4: Discuss the Right Treatment for the Form of Lyme Disease
Lyme disease is caused by bacteria, so evidence-based treatment uses antibiotics. Supplements, detox plans, dietary changes, chiropractic care, and other supportive strategies should not be used as substitutes for appropriate antibiotic care.
For uncomplicated early Lyme disease with an erythema migrans rash, the CDC lists oral doxycycline, amoxicillin, or cefuroxime as common options. Depending on the medication, treatment generally lasts 10 to 14 days. The correct drug and duration depend on age, pregnancy status, allergies, other medical conditions, medication interactions, and the way Lyme disease is affecting the body. Early treatment is usually followed by rapid and complete recovery (https://www.cdc.gov/lyme/hcp/clinical-care/erythema-migrans-rash.html).
Heart involvement, meningitis, certain nerve problems, or significant arthritis may require a different medication, a longer course, IV treatment, an ECG, hospital monitoring, or specialist care. The joint IDSA, American Academy of Neurology, and American College of Rheumatology guideline https://www.idsociety.org/practice-guideline/lyme-disease/ recommends treatment based on the specific manifestation rather than using one protocol for every positive test.
Do not start leftover antibiotics, borrow someone else’s prescription, or extend treatment on your own. These choices can cause side effects, drug interactions, C. difficile infection, and antibiotic resistance while delaying the correct diagnosis.
Step 5: Ask Whether Another Tickborne Infection Should Be Considered
Blacklegged ticks can carry more than one pathogen. This is especially relevant in Lyme-endemic regions such as Wisconsin and other parts of the Upper Midwest and Northeast.
The most common Lyme coinfection is anaplasmosis. Babesiosis and several other tickborne infections occur less often, but they may require different testing and treatment. Your clinician may consider coinfection when symptoms are unusually severe, fever remains high, blood counts or liver tests are abnormal, or improvement does not occur as expected.
Testing everyone for every possible organism is not automatically helpful. The decision should be based on your symptoms, location, exposure, examination, and initial laboratory findings. The CDC provides a helpful overview of Lyme testing and tickborne coinfections https://www.cdc.gov/lyme/diagnosis-testing/index.html.
Step 6: Support Recovery Without Replacing Treatment
While your medical clinician addresses the infection, support the basic systems your body uses to recover:
- Take every medication exactly as prescribed and report side effects promptly.
- Prioritize consistent sleep and allow extra recovery time if fatigue is significant.
- Stay hydrated and eat regular, nutrient-dense meals with adequate protein.
- Use gentle movement as tolerated, but do not force intense exercise through fever, dizziness, marked fatigue, chest symptoms, or neurologic symptoms.
- Keep a simple daily record of temperature, rash changes, pain, energy, sleep, neurologic symptoms, and medication reactions.
- Review every supplement with your pharmacist or prescribing clinician to avoid interactions.
No supplement has been proven to eradicate Lyme bacteria. Supportive care may improve comfort and resilience, but it should complement—not replace—appropriate medical treatment.
What If You Still Feel Unwell After Treatment?
Recovery does not always happen overnight. Some people continue to experience fatigue, body aches, or difficulty thinking after recommended treatment. The CDC calls this Post-Treatment Lyme Disease Syndrome (PTLDS); its cause is not yet known.
Persistent symptoms should be taken seriously, but they do not automatically prove that live bacteria remain. A thoughtful follow-up should look for objective signs of ongoing or new Lyme disease and consider other possible contributors, including anemia, thyroid disease, sleep disorders, medication effects, autoimmune conditions, other infections, mood disorders, and deconditioning.
For people who have completed recommended therapy and have nonspecific symptoms without objective evidence of reinfection or treatment failure, studies have found that additional or prolonged antibiotics are unlikely to help and may cause serious harm https://www.cdc.gov/lyme/signs-symptoms/chronic-symptoms-and-lyme-disease.html.
Questions to Ask Before You Leave the Appointment
1. Does my complete test meet the recommended two-step criteria?
2. Do my symptoms and exposure history fit current Lyme disease?
3. Could this result reflect a previous infection or a false-positive reaction?
4. Which form of Lyme disease do you believe I have?
5. What treatment do you recommend, and why?
6. Do my symptoms suggest heart, neurologic, joint, or coinfection involvement?
7. What side effects or warning signs should prompt an urgent call?
8. When should I follow up, and how will we judge recovery if repeat antibody testing is not a test of cure?
A Note About a Tick That Tests Positive
If a laboratory found Lyme bacteria in a removed tick, that does not mean the person it bit has Lyme disease. Tick testing does not reliably predict whether transmission occurred and should not be used by itself to diagnose infection or determine treatment. Contact a medical clinician to review the tick species, estimated attachment time, location, symptoms, and whether the bite qualifies for time-sensitive preventive treatment.
The Bottom Line
A positive Lyme test is the beginning of a clinical conversation—not the entire diagnosis.
Confirm the testing method. Match the result to your symptoms and timeline. Watch for urgent warning signs. Get the correct treatment for the specific way the disease is presenting. Then support your recovery with sleep, hydration, nourishing food, appropriate movement, and careful follow-up.
Most people treated appropriately, especially early in the illness, recover well. Move forward with urgency when needed, but also with clarity, wisdom, and a plan.
For more natural health education and practical wellness guidance, visit [DrChad.com](https://www.drchad.com/).
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Recommended Wellness Resources
These resources do not diagnose or treat Lyme disease. Lyme testing and antibiotic treatment should be directed by an appropriately licensed medical clinician. Some links may be affiliate links, which means Dr. Chad Wellness, LLC may receive compensation at no additional cost to you.
Medical Disclaimer
This article is for educational purposes only and is not medical advice, diagnosis, or treatment. It does not establish a doctor-patient relationship. Do not delay or disregard care from a licensed physician, advanced practice clinician, or other qualified healthcare professional because of information in this article. Call 911 or seek emergency care for severe or rapidly worsening symptoms.
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