Choosing Wisely:

Don’t order Lyme serology on patients with a primary erythema migrans lesion.

Rationale and Comments: No current diagnostic method is highly sensitive in Lyme disease patients with less than two weeks of rash or illness. Most patients with primary Lyme disease are seronegative at the time of presentation and should be treated on clinical grounds regardless of serological results. In patients with equivocal or atypical lesions, paired testing with sera collected acutely and two to three weeks later may be helpful.
Sponsoring Organizations:
  • American Society for Microbiology
  • Sources:
  • IDSA guideline
  • Disciplines:
  • Infectious disease
  • References: • Moore A, Nelson C, Molins C, Mead P, Schriefer M. Current guidelines, common clinical pitfalls, and future directions for laboratory diagnosis of Lyme disease, United States. Emerg Infect Dis. 2016;22(7): 1169-1177.
    • Draft Clinical Practice Guidelines by the Infectious Diseases Society of America (IDSA), American Academy of Neurology (AAN), and American College of Rheumatology (ACR): 2019 Guidelines for the Prevention, Diagnosis and Treatment of Lyme Disease.
    • CDC Lyme Disease Resources: https://www.cdc.gov/lyme/index.html
    • Wormser GP, Dattwyler RJ, Shapiro ED, et al. The clinical assessment, treatment, and prevention of lyme disease, human granulocytic anaplasmosis, and babesiosis: clinical practice guidelines by the Infectious Diseases Society of America. Clin Infect Dis. 2006;43(9):1089-1134.

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