yep, Girlie gave the top level summary
the background is that many many studies have found both IgG and IgM antibodies can persist for many months or years after infection has been successfully treated.
conversely western blot misses a significant portion of active infections ( such is the problem with serology based tests )
unfortunately, its well known that there is, as yet, no test that can prove definitively that the infection is in fact gone.
given this fact is surprising that some actual LLMD's continue to do this WB test after treatment
( we see the question come up here from time to time )
perhaps for the LLMDs ( and their patients) its temptind to look for some form of confirmation of treatment efficacy.
eg. if a person was once fully positive via WB - was treated for 12 months - then retested -
if they then presented no bands - this might be interpreted as confirmation of successful treatment
but i would caution against this approach as its, clearly inviting confirmation bias and not supported by the published science on the topic - which shows the long term antibodies after treatment issue, on top of the known poor sensitivity of western blot test in general, so, infected persons can often show up with no bands ( i had a completely clear WB test when i was still very ill ) or only a couple of bands.
its also clear from members repeat testing and reporting their results here - that different bands and different numbers of bands often turn up when the same person is tested over time - sometimes less / sometimes more - regardless of their symptoms.
we also see the opposite happen where patients are negative initially via WB - then after or during antibiotic therapy they light up lots of bands on the western blot - as if the abx killing lots of bacteria suddenly "woke up" the immune system to the threat
until we have a test that can reliably tell if all spirochetes are in fact gone - we will, as girlie suggests, be reliant on symptoms as the main guide
it may even be that once in infected by borrelia - and especially if the infection has had chance to become chronic - that its simply not possible to eradicate it all together and treatment goals are instead therefore to suppress the infection to the point where the immune system can keep it under control so that it produces no overt symptoms.
this does not have to be alarming - it may simply be the nature of things - as this is exactly what happens with many viruses we all get during our childhood and teens - eg chickenpox. it may well have been the case for many of us that we were infected many years before becoming ill with symptoms and our immune systems had it under control all this time - until some kind of immune insult - which reduced our resistance and suddenly we become ill.
if that is the case then this could be one explanation for ongoing antibody responses in persons who have been successfully treated - at this point in time we simply do not know.
finally, the normal rules of thumb around IgG and IgM do not apply to complex chronic infections like Lyme.
ongoing IgM responses are common - i have explained the reasons in the other thread on testing on the first page
here is a reference in the scientific literature for long term IgG and IgM antibodies after successful treatment
https://www.ncbi.nlm.nih.gov/pmc/articles/pmc264030/sorry its not more clear cut - this is exactly the problem with serologic testing and why we need better direct tests as a priority
i hope its helpful
Post Edited (Garzie) : 2/1/2023 8:37:43 AM (GMT-8)