OK that worked fine
the test was done by Quest
their diagnostic criteria is that BOTH
1, the initial EIA IgG test must be positive or equivocal -
AND
2, the IgG immunoblot must be positive also
in order for the patient to be given a positive test result
the IgG immunoblot is - acc to Quest only considered positive if 5 or more bands are detected -
so since you had a negative first tier test result - then according to this criteria the test is regarded as negative
( the IgG immunoblot is disregarded is the first test is negative)
so we can say the test lab and the doctor are in agreement
however - there is a great deal of controversy over the accuracy of such testing
the problems include multiple facets of the testing issue
questions include
-whether the two tier approach itself is correct ( normally the more sensitive test is used in the first step of a two tier approach - but in the lyme case it is the reverse - the logic for this backwards approach is not clear)
-whether the tests technology itself is accurate - many peer reviewed studies disagree - some funded by test manufacturers claim up to 99% sensitivity - whereas many by independent researchers place the figure at more like 20-50%
- whether any serologic test can ever reliably detect infection with an organism that interferes with the host ability to produce the very thing that the test looks for - antibodies
the CDC website is a confused mess when it comes to lyme disease - some would say that this is how they intend it to be - but after a ridiculous amount of digging ( you would think it would be on the first lyme disease testing page) - they are constantly tinkering with wording - adding pages and taking pages away - some pages conflict with others - anyway i found this document which appears to be current and defines how they believe the two tier test should be interpreted
https://www.cdc.gov/lyme/media/pdfs/2024/05/Standard_Two_Tiered_Testing_Suggested_Results_Reporting_Interpretation.pdf
it says
"Immunoblots for IgG antibodies to B. burgdorferi are interpreted as “negative” if <5 B. burgdorferi-specific proteins are detected. Conversely, if ≥ 5 out of a possible 10 B. burgdorferi-specific proteins are detected, the immunoblot is interpreted as “positive” for IgG-class antibodies to B. burgdorferi. The B.
burgdorferi-specific proteins that may be detected include: p18, p23, p28, p30, p39, p41, p45, p58, p66, p93."
the title of the table in the document is as follows
"Table 1a. Suggested Guidance for Reporting Results from the Standard Two-Tiered Lyme Disease Serologic Testing Using a Total Ig Immunoassay as a First Tier Assay"
so without stating it explicitly - it would seem that the CDC is publishing the reporting criteria for official statutory reporting of lyme disease cases ( Lyme is a reportable disease in the USA) - but at the same time implying that this should be used for ALL interpretation of patient immunoblot results.
this is something it EXPLICITLY advises against on other pages on the same website! ( see quote in my first post above on surveillance criteria )
in other words - its a mess - almost as if its been designed to confuse the reader / public and doctors alike.
so, as far as i can see from the current web page - it would seem that Quest is strictly following the CDC guidance ( but whether or not that is the best approach is a separate question )
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so moving to your second question - if you wanted to test at Igenex in the hope of getting a positive result = say to convince a doctor to treat you - for instance
their list of tests and recommendations of when to use them is here
https://igenex.com/disease/borrelia/igenex would normally suggest a two tier approach also
typically one of :
Lyme IgG/IgM Antibody Serology
or
Lyme Screen Immunoassay (LSA) - NEW!
followed by an immunoblot type test for borrelia :
Lyme ImmunoBlot
often to try to get a clearer picture people add a third test - one that uses a different approach to the above serologic tests: eg the IgX Spot
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all that said and given what has been posited above - it seems highly likely based on the history and the quest result that you do have lyme - and since lyme is actually a clinical diagnosis according to all current published guidelines -( ie done by a doctor - based on symptoms, history, exam etc) - you may choose to go directly to a lyme literate doctor for diagnosis and if confirmed - treatment - rather than pursing more expensive testing - when - even if it comes back positive ( it may be negative or equivocal - even at Igenex and if you have lyme disease ) - may not convince a conventional doctor to treat you appropriately.
i am sorry its not as clear cut as you had hoped - we simply do not have good enough tests for that yet - and there is still a great deal of miseducation and denial from conventional doctors.