Often, when we get to drawing blood at a physical exam, a patient will say, "Test me for everything."  Obviously, everything is not possible - so a discussion of what "everything" entails is needed.  Usually, patients use "everything" as a signal for testing for sexually transmitted diseases.  It is important to know that HIV can not be tested for without your request - so do not assume it is being tested - ASK FOR IT! 

Component of Blood

So what is in a standard battery of tests - STD and non-STD?  Standard tests at a physical include a blood count, liver and kidney function, and sugar levels.  Cholesterol levels and thyroid function is checked as well.  Urine will also be tested for infection, sugar and kidney function.  Often, iron levels, Vitamin B12 and Vitamin D will be checked.  High Sensitivity C-reactive protein may be checked - depending on cardiovascular risk factors - it should be noted that women on birth control pills will often have an artificially elevated level.

STD tests usually include HIV, syphilis, gonorrhea, chlamydia and Hepatitis B & C.  Herpes can be tested for in the blood as well, but the test only shows whether a person has been exposed to the Herpes virus, it does not give information on contagiousness or disease activity.

HPV is tested for in women during a PAP smear.  It is a test done on cervical cells - it is not a blood or urine test.  There is no test for men for HPV, unless there is a lesion - usually a wart - that can be biopsied.

Blood tests for cancer or genetic information are not routinely done, with the exception of the PSA in men for prostate cancer.  While there are tests that exist for following some cancers, they are not proven to improve diagnosis - even the CA-125 test that is touted in many email chain letters for ovarian cancer - it is not a diagnostic test but rather a test for following someone with ovarian cancer.

This leads to the biggest issue of testing - interpreting the information in a meaningful way for an individual.  As more tests are developed, our need to synthesize this information to make good decisions is becoming more apparent.  For more on this see the recent Expert Panel post by Alexander Tsiaras - Diagnostics Made Understandable.

He highlights the need for good interpretive tools as well as a relationship with your physician to understand your data and map your path to health.

So, "everything" means different things to different people - so be specific if there is something you wish to have tested.  You can't assume it is part of everything.