Evidence matrix
Different tests answer different questions.
Compare what each approach measures, how the sequence works, when timing matters and what the result cannot prove.
Status describes use or development—not a quality score.
Lyme testing evidence comparison
01STTT
Standard two-tier testing
Recommended antibody method - What it measures
- Antibodies made by the immune system in response to Borrelia burgdorferi.
- How it works
- First-tier EIA; a positive or equivocal result continues to an IgM and/or IgG immunoblot.
- Timing
- May be falsely negative in the first several weeks. Interpretation of IgM depends on illness duration.
- What it cannot tell you
- Cannot determine whether an infection is currently active or whether treatment worked.
02MTTT
Modified two-tier testing
FDA-cleared alternative sequence - What it measures
- Antibodies made by the immune system in response to Borrelia burgdorferi.
- How it works
- A first EIA is followed by a second, different EIA when the first is positive or equivocal.
- Timing
- The same early antibody window matters. Assays must be FDA-cleared for use together in the sequence.
- What it cannot tell you
- Cannot date the infection from one result or function as a test of cure.
03Research
Emerging direct-detection and immune approaches
Development and evaluation - What it measures
- Depending on the approach: bacterial components, immune-response patterns or other diagnostic signals.
- How it works
- There is no single emerging test pathway. Each method needs its own evidence and regulatory-status review.
- Timing
- The intended diagnostic window and studied population vary by technology.
- What it cannot tell you
- Promising research does not establish routine clinical availability, performance or FDA clearance.
Primary sources
Read the reporting guidance behind the matrix.