In the real world practice the treatment of chronic LD has one more difficulty that is lack of accurate and sensitive tests that can correctly diagnose and monitor the Lyme infections. There is no test that is reliable enough to show the real infectious status of the patient. It is difficult to evaluate the treatment responds and to determine the endpoint of the treatment. What we can do is only rely on symptomatic evaluation, but it is subjective.
Nowadays the commonly used diagnostic tests are testing the serum antibodies level of the patient that can only tell whether the patient had contracted the pathogens before; it can’t tell whether the pathogens are still there in the body or the amount of the pathogens are there. There are some methods such as PCR test to detect and measure the DNA of pathogens or to culture the pathogens in a culture dish, those tests not only very expensive and takes long time to have results but also have very low sensitivity that can make a lot of fouls negative results. They are not reliable too. Thus to evaluate the efficacy of treatment is almost impossible. The only way we can use is to record the symptom changes, but it does not produce quantitative figures and the data collected is not subjective and convincing. We are badly needing accurate and sensitive tests to be developed to enable an accurate diagnose and evaluation of the Lyme disease during treatment course and to be able to determine the endpoint of the treatment objectively.