IgM and IgG antibody levels are widely used in the routine practice. However, they may be elevated for years even after successful treatment with antibiotics. What other options ( such as C6 peptide assay) could be used as an accurate diagnostic tool?
Serology may confirm clinical disease (Lyme disease). However, as a sole method for diagnosing Lyme disease, serology is not appropriate. Depending on the “school” you are following, Lyme disease is primary a clinical diagnosis, based on typical symptoms. The presence of specific antibodies may support the clinical diagnosis (and their absence should cause caution in drawing the diagnosis Lyme disease).
Following treatment, the clinical success is the most appropriate marker. You may expect a decline in antibody titres after treatment, but this decline is - as you stated - slow and must not necessarily occur.
As a surrogate for successful therapy, serology is – that’s my opinion – not appropriate.
Some groups have spent work on cellular immune response (e.g. EliSpot) but there is no consensus yet on the actual value of this diagnostic method in clinical and diagnostic routine.
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