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What is a smear for microflora in women? A smear for bacteriological flora is a fairly simple analysis; it checks for the presence of microflora in a woman’s vagina, uterine and urethra. Such a smear for microflora differs from a cytological analysis performed on a woman with suspected uterine cancer.

Even in a completely healthy woman, a certain microbial environment lives in the vagina, just like in all other cavities (mouth, nose, etc.) in humans. This is considered quite normal. The main representatives of the local environment are lactobacilli - microscopic rods, the waste product of which is hydrogen peroxide, which oxidizes the internal environment.

Pathogenic microbes do not multiply in such an environment. So lactobacilli play a kind of protective role, inhibiting the growth of potentially dangerous bacilli. In addition to them, a small number of streptococci and staphylococci, Candida fungus and ureaplasma live in the vagina.

With the development of gynecological pathologies and infectious diseases transmitted through sexual contact, the microbial composition in the vaginal environment can change dramatically, which provides an opportunity for comparative analysis. Characteristic changes can also determine its cause.

The vaginal composition is directly affected by the composition of the microflora of the uterine cervix and urethra, resulting in a mixed environment.

Preparing for analysis

What you need to know when ordering such an analysis:

1. Refrain from sex life 2 days before the examination.
2. You should not use any hygienic or medicinal products for external treatment 2 days before the test.
3. Hygiene procedures are carried out in the evening simply warm water, it is not advisable to do anything in the morning.
4. It is not recommended to go to the toilet 3 hours before the test.

In days menstrual cycle It is not recommended to take such tests. You need to do this either before your critical days or after them.

Microflora smear analysis

During a test smear, mucous secretions from the vaginal passage, uterine cervix and urethra are used. Taking a smear is a standard procedure during a gynecological examination.

First, a visual inspection is carried out using a “mirror” - a plastic or metal expander. Using the instrument, the vaginal walls are expanded and a consolidated view of the surface is formed. The feeling when inserting it is unpleasant and slightly painful. In this case, you should breathe as deeply as possible, without straining, this will make the procedure somewhat easier.

After the examination, the gynecologist collects microflora from the walls of all canals using a sterile swab. This procedure is considered painless, with the exception of some discomfort directly when the tampon comes into contact with the tissue.

The resulting samples are collected on glass slides and sent for study to the laboratory, where they are stained with a special solution and studied in detail under magnification. The decoding of the analysis is carried out there, in laboratory conditions, within a few hours or at most days.

The results of a visual examination may give rise to a smear on cytological medium or colposcopy.

Implications of the analysis

Complications after sampling are usually not observed, except rare case in the form of minor pain and mucous discharge. Even these infrequent manifestations disappear after a couple of hours.

Apart from the procedure of colposcopy and uterine biopsy, other similar tests do not require a special regime after them or any abstinence. If, after a certain time after the examination, heavy bloody issues, the temperature has risen, chills have begun, you should immediately seek medical help.

During the entire pregnancy cycle you need to be examined at least three times. The first analysis is carried out when a woman is diagnosed with pregnancy. The next time a smear is performed is in the middle and end of pregnancy. The analysis is completely safe for both the woman herself and the unborn child.

Diseases detected by microflora analysis

Through this analysis, it is possible to identify such female diseases as vaginosis, vaginitis, cervicitis, thrush, as well as sexually transmitted diseases: chlamydia, gonorrhea, trichomoniasis, etc. If an infectious disease is detected, the standard smear is supplemented with a special cultural analysis to determine the number of microorganisms in the genital tract. In addition, PCR diagnostics can be used, which accurately detects any infections.

Analysis transcript

Microflora determined during analysis:

1. Leukocytes are cells that represent the immune system. Normally present in small quantities. An increase in the norm indicates a possible infectious disease. During pregnancy, their content may be slightly higher.
2. Lactobacilli are typical representatives internal environment vagina, are extremely necessary for him to maintain the normal balance of other microorganisms. Normally, there should be a fairly large number of them; a decrease in it indicates the risk of the disease or its presence.
3. Yeast bacteria - presence in small quantities is quite acceptable. But if their norm is clearly exceeded, then this may indicate progressive thrush.
4. Squamous epithelial cells - this material constantly peels off from the walls of the vagina. Its amount depends on the time of the menstrual cycle. Exceeding its norm indicates a possible inflammatory process.
5. A certain amount of mucus is acceptable, but too much mucus may indicate an infection.
6. Key cells are squamous epithelial material, with bacteria on the surface. Exceeding their norm will indicate bacterial vaginosis.
7. E. coli - represents the intestinal microflora and is found in moderate quantities in the vagina even in completely healthy women. Its excess indicates the presence of the same bacterial vaginosis or simply poor hygiene.
8. Staphylococci and streptococci are fairly common microorganisms in the vaginal environment, but their excess under certain conditions can lead to an infectious disease.
9. Gardnerellas are permissible only in small quantities.
10. Gonococci should normally be absent. Their presence indicates existing gonorrhea.
11. Trichomonas - indicate the presence of trichomoniasis.

Any diagnostic method does not exclude errors, so if you get bad results, you should insist on repeating the analysis.

If they are nevertheless confirmed, do not fall into despair; today there is a fairly effective treatment for such diseases. It is strongly not recommended to treat the pathology yourself. Any treatment should be determined only by a doctor. In addition, you should not rely on the fact that a bad result is a consequence of insufficient hygiene. Attempts to simply wash pathogenic microflora out of the vagina by douching will only lead to a worsening of the situation.

A smear is an examination method in which the doctor collects a small amount of material from the surface of the mucosa. Smear analysis is most often used in urology in men and in gynecology in women. Examination of a smear for flora allows you to check for the presence of pathogenic bacteria, cancer cells, and in some cases, assess hormonal levels and the general condition of the tissue. A vaginal smear for flora is taken once every three months, during routine examinations with a gynecologist.

If you are undergoing treatment, a swab test for infection will be taken after the end of treatment to confirm its success. A vaginal or cervical test is a painless procedure that provides insight into a woman's health.

Gynecological smear - 4 main types:

1. Smear on the flora.

2. Smear for sterility.

3. Cytology smear (PAP test for atypical cervical cells).

4. Smear for latent infections (PCR).

1. Smear on flora: norm and deviations from it

Why it is carried out: The study allows you to evaluate the microflora - the presence of pathogenic bacteria and their quantity.

Such an analysis, taken from a healthy woman, should show 95% of lactobacilli in the collected material. Lactobacilli produce lactic acid, thereby protecting the genitals from infections and maintaining the desired acidity. In pregnant women, the number of lactobacilli decreases, so the body’s natural defenses are weakened. In order to prevent the development of diseases that cause sexually transmitted infections, a smear during pregnancy should be taken by all expectant mothers, without exception.

Vaginal smears are examined to ensure the absence of infectious agents, such as:

• Trichomonas;
• gardnerella.

To identify infections that cannot be detected by flora analysis, a smear is taken for hidden infections. One of the most common methods for detecting hidden infections is the PCR method.

Normally, the microflora of a healthy woman may contain gardnerella and candida, but their quantity should be low. Gardnerella and candida begin to actively develop when immunity decreases. The body's defenses can be weakened for various reasons:

• pregnancy;
• fatigue;
• emotional fatigue;
• the presence of a disease that the immune system is “busy” fighting.

When assessing it, four purity groups are distinguished.

• First. The reaction is acidic - pH 4.0–4.5. Most microorganisms are Doderlein bacilli (aka lactobacilli), in small quantities - leukocytes in the smear, epithelial cells. Such results indicate a healthy reproductive system.
• Second. The reaction is acidic - pH 4.5–5.0. In addition to lactobacilli, there are gram-negative bacteria - these are most often the causative agents of infections, which become discolored after laboratory staining.
• Third. The reaction is alkaline or slightly acidic - pH 5.0–7.0. Mainly bacterial microflora, epithelial cells are also in large numbers. Several lactobacilli were detected.
• Fourth. The reaction is alkaline - pH 7.0–7.5. There are no lactobacilli, the flora is represented by pathogenic organisms. There are a large number of leukocytes in the smear. This analysis indicates inflammation of the vaginal mucosa.

If the result is bad (group 3 or 4), your doctor may refer you for a repeat test or culture to confirm the results.

Decoding

Results may vary from laboratory to laboratory. Depending on which laboratory you took the smear from, the norm may vary. Since research methods may differ in each individual laboratory, the results will be different. It is advisable to take all tests in one laboratory so that you can observe changes over time and these changes are not associated with a change in the laboratory where you take tests. Decoding must be carried out by a doctor.

To indicate the number of bacteria when examining smears from the urethra, vagina, as well as when analyzing a cervical smear, CFU/ml is used. These units of measurement are read as quantities colony forming units per milliliter of liquid.

2. Smear test for sterility

Why it is performed: it allows you to determine the presence or absence of sexually transmitted infections, assess the woman’s hormonal background, as well as the composition of the vaginal contents; during pregnancy, the results of a smear allow you to assess the threat of miscarriage.

This test is called a smear for purity, or a vaginal smear for sterility.

The study is carried out according to the following indicators:

• Flat epithelium

Flat epithelium - cells of the mucous membrane of the cervix and vagina. An analysis of a woman who is healthy will definitely show it in small quantities. If there is no epithelium in the smear, this indicates hormonal disorders, while the level of androgens is increased and estrogen levels are decreased. An increased amount of epithelium indicates inflammation.

A cervical smear with an increased level of squamous epithelium indicates inflammation in the cervix, a smear from the urethra - in bladder, a vaginal smear, respectively, for inflammation of the vaginal walls.

The amount of squamous epithelium is also affected by the phase of the cycle. Depending on what day the flora analysis was done, the norm varies.

If you have taken a smear for flora, it should be deciphered by your attending physician.

• Lactobacilli(synonyms: gram-positive rods, lactobacilli or Doderlein rods)

With healthy genitals, lactobacilli (bacillus) predominate in the smear. The results of smears in which the number of lactobacilli is 95% of the total number of bacteria are considered good. Sometimes during the study the number of lactobacilli is lower than normal. At the same time, the acidity in the vagina decreases and it is easier for pathogenic microbes to enter the body.

• Leukocytes

When examining smears, the number of leukocytes is determined - this is one of the important indicators.

Leukocytes are the “defenders” of the body. Leukocytes in a smear are present in large numbers when pathogenic bacteria are actively multiplying in the body. That is, the more leukocytes are elevated in the analysis, the more pronounced the inflammatory process.

If a cervical smear contains up to 30 leukocytes, from the urethra - up to 5, and from the vagina - up to 10, this is normal. Such meanings are typical for all women who are sexually active.

Leukocytes in a smear, the norm of which is significantly increased, only indicate the presence of an inflammatory process. The cause of the infection must be determined by a doctor. To do this, it is necessary to conduct additional studies, such as bacterial culture, immunological analysis and polymerase chain reaction (PCR).

• Red blood cells

The number of red blood cells increases during menstruation, trauma to the vaginal mucosa or inflammation. The analysis may normally contain several red blood cells.

• Slime

Mucus is secreted by the glands of the cervix and vagina - a smear from the vagina and cervix should contain a small amount of it.

3. Smear for latent infections and polymerase chain reaction

Why it is carried out: allows you to detect infections that cannot be detected by analyzing a smear for flora

In 1983, American biochemist Kary Mullis developed the polymerase chain reaction method, for which he was awarded the Nobel Prize. Thanks to the scientist, it became possible to “recognize” bacteria and viruses by sight, even in their minimal quantities. Polymerase chain reaction is often called PCR diagnostics. PCR analysis and PCR smear are also synonymous. A smear, scraping or urine sample taken for analysis can reveal hidden diseases.

Polymerase chain reaction is a method biological research, in which a section of DNA is multiplied in the laboratory.

Why is PCR analysis needed? When researching, it is necessary to identify what type of infection causes the disease. But sometimes there are so few bacteria that it is impossible to recognize them. In such cases, PCR diagnostics of infections comes to the rescue.

For analysis, a section of bacterial DNA is taken and cloned many times. When the DNA “grows”, it is possible to determine what type of bacteria or fungi the laboratory technician is dealing with.

PCR diagnostics of infections gives an accurate result. It allows you to identify not only the genus, but also the type of bacteria: for example, not only to say that the fungus is of the genus Candida, but also to clarify that it belongs to Candida albicans. If the exact type of infection is not determined, treatment may not be effective.

PCR diagnostics are often used to test smears for sexually transmitted infections. Most sexually transmitted diseases, such as gardnerellosis, chlamydia, mycoplasmosis, gonorrhea, ureaplasmosis, are early stages development may not show signs. Symptoms appear in later stages. Thanks to PCR analysis, sexually transmitted infections can be detected at the initial stage of development and, accordingly, quickly cured.

When carrying out such an analysis, viral infections such as hepatitis or papilloma can also be detected. Other methods can detect not the virus itself, but only the presence of its metabolic products or antibodies to it.

The polymerase chain reaction method allows you to detect infections in any environment: in blood, urine, saliva, and on mucous membranes. In addition, thanks to PCR analysis, viruses are isolated in soil and water.

Advantages of polymerase chain reaction:

• accuracy of infection detection;
• the ability to isolate the virus (and not decay products or antibodies to it);
• a small amount of test material is sufficient (even in the presence of one pathogen cell);
• the ability to detect infection in any environment (urine, blood, saliva);
• speed of analysis;
• the only method for isolating certain infections.

4. PAP test, or cytological smear

Why it is carried out: allows you to diagnose cervical cancer.

The Pap test has different names: a smear for cytology, as well as a test, analysis or smear according to Papanicolaou, a smear for atypical cells. The test is named after the Greek scientist who first used this method. To perform a Pap test, a swab is taken from the cervical canal (cervix) during an in-chair gynecological examination.

A cytological smear in a woman over 30 years of age is a mandatory annual test. Cervical smear results help diagnose cervical cancer, the second most common cancer among women.

How is a smear taken for cytology?

Several factors may influence the results of the study. To get a reliable result, refrain from going to the toilet 2-3 hours before taking a smear. Otherwise, you will wash away the epithelium and bacteria that are important for examining a vaginal smear.

To ensure accurate results, 48 ​​hours before the test:

• don't have sex;
• do not douche (so as not to wash the vaginal contents);
• do not use vaginal contraceptives (spermicidal creams, ointments, foams);
• do not take baths;
• Do not use tampons or vaginal suppositories.

Taking a smear from the cervix

The interpretation of the smear and, accordingly, the success of treatment depend on whether the woman followed the requirements listed above. A Pap smear can be taken on any day of the cycle when there is no menstrual flow.

A smear is taken by a gynecologist during an examination on a chair.

Eyre spatula - a plastic stick for taking a cervical smear

In this case, the doctor uses a speculum and an Eyre spatula - a special plastic stick. Taking swabs takes no more than two minutes. The procedure is painless.

Smears are taken in three places - possible foci of infection: a smear is taken from the cervical canal (cervix), from the vagina and urethral opening.

Taking smears from the cervical canal

The study is carried out by studying under a microscope or bacteriological culture. In most cases, women do not experience any discomfort after a smear. Only occasionally may spotting from the vagina and painful sensations in the lower abdomen be observed. They should go away in a few hours.

There is no need to abstain from sex after a smear. Starting from the age of 18, even if a girl is not sexually active, experts recommend undergoing annual preventive examinations and taking a smear for oncocytology. And those who are sexually active, regardless of age, are advised to visit a gynecologist at the beginning intimate relationships. To detect cervical cancer in the early stages of development, after 30 years of age, be examined by a gynecologist at least twice a year.

Cervical dysplasia

If there are “wrong” cells as a result of cytology analysis of a cervical smear, the doctor uses a special term: dysplasia.

Dysplasia is a condition of the cervix in which some of the cells have a damaged structure. This means that the cells can develop into cancer. Therefore, such a pathology may be a precancerous condition.

What influences the development of cervical dysplasia?

The risk of developing pathology increases with:

• smoking;
• a large number of births;
• long-term use of intrauterine and hormonal contraceptives;
• lack of vitamins;
• the presence of sexually transmitted infections (especially papillomavirus);
• early sexual activity (up to 16 years);
• childbirth (up to 16 years);
• large quantities sexual partners(three or more);
• genetic predisposition.

Cervical dysplasia is caused by human papillomavirus (HPV) types: 6, 11, 16, 18, 31, 33 and 35.

Signs may include:

• frequent inflammatory processes;
• spotting bloody discharge;
• bleeding after sexual intercourse or when using tampons.

Some women with dysplasia experience pain in the lower abdomen.

Dysplasia: degrees of development

Depending on how much dysplasia has developed, the degree of its development indicates the depth of tissue damage. There are three degrees: first, second and third.

Degrees of cervical dysplasia

• TO first degree Dysplasia refers to slight changes in the structure of the cells of the cervix. In this case, abnormal cells affect only the superficial layer of squamous epithelium.
• At second degree Cervical dysplasia “irregular” cells affect the superficial and middle layers of the cervix.
• Cervical dysplasia third degree means that abnormal cells have grown into all three layers of the epithelium.

Cervical dysplasia: treatment

Cervical dysplasia. HPV - human papilloma virus

If you have cervical dysplasia, treatment involves reducing the number of abnormal cells. To do this, the doctor removes a small affected area of ​​the cervix. If you have been diagnosed with cervical dysplasia, treatment may not completely remove the human papillomavirus from your body. However, it can prevent the development of a malignant tumor.

Treatment of the disease - removal of the affected area - the uterus - can be carried out in different ways: using a laser, freezing and other methods. This depends on the woman’s age, the degree of development and the condition of other genital organs. If the patient has sexually transmitted infections, they are eliminated first. Only after a smear analysis shows that there are no sexually transmitted infections is treatment carried out.

When cervical dysplasia is detected in the early stages, treatment is carried out, which not only preserves women's health, but also life. To do this, every woman should undergo preventive examinations at least once a year.

Who needs to be examined by a gynecologist?

A smear examination of the vagina, urethra and cervix should be performed on women who:

• began to be sexually active;
• got pregnant;
• planning pregnancy;
• have multiple sexual partners;
• feel discomfort in the genitals (pain during sex, frequent urination or burning in the genitals, and others);
• over 18 years old;
• undergo a preventive examination.

Regular examinations in the gynecologist's office, during which you can take a smear test, allow you to notice the onset of the disease in time, make the correct diagnosis and even save your life. For example, uterine dysplasia, the treatment of which was started on time, will not degenerate into an incurable malignant tumor.

Smear: norm and deviations, or Who is at risk

Regardless of age, there are factors that increase your risk of cervical cancer. Their combination and prolonged “effect” on the body reduce the body’s defenses in the fight against the disease, even in the early stages of development.

It is especially important to take a cervical smear for oncocytology for women who:

• have multiple sexual partners;
• started sexual activity before the age of 18;
• have had cancer of the reproductive system in the past;
• smoke;
• are carriers of viral infections;
• have weakened immunity.

Viral infections such as: herpes simplex virus, HIV and human papillomavirus.

• inflammation of the vaginal mucosa;
• dysbacteriosis of vaginal microflora;
• intestinal dysbiosis;
• sexually transmitted diseases;
• inflammation of the uterine mucosa;
• tumor processes in the pelvic organs;
• inflammation of the uterine appendages;
• fungal infection of the vagina;
• urethritis;
• inflammation of the cervix.

There are situations when elevated white blood cells do not indicate the presence of a pathological inflammatory process in the reproductive system. In particular, an increase in the content of white blood cells in a smear may be a consequence of inflammation in the male genitourinary system. For example, after unprotected sexual intercourse with a man who suffers from prostatitis, leukocytes in the smear will be in increased numbers. This must be taken into account by the doctor when carrying out diagnostic measures.

Elevated leukocytes in a smear in men

To find out the cause of infertility, men also take a smear from the urethra. An increase in the number of white blood cells indicates the presence of an inflammatory process in the genitourinary system in men. These pathological conditions can lead to reproductive dysfunction and infertility. In addition, if inflammatory diseases of the pelvic organs in men are not treated, the pathological process can spread to nearby organs or even lead to the development of systemic inflammation.

Therefore, elevated white blood cells in representatives of the stronger sex are a serious marker of an infectious process that must be diagnosed and treated in a timely manner. To do this, the doctor prescribes appropriate treatment, which in most cases has a positive effect. Pathological changes in a smear in the form of an increase in leukocytes can be a sign of diseases such as cystitis, prostatitis, orchiepididymitis, and so on. In these pathological conditions, a man experiences pain or a burning sensation when urinating, as well as cloudy urine. In addition, elevated white blood cells can be detected after sexual intercourse with a woman who suffers from inflammatory diseases.

Thus, a smear should be taken in both women and men. This study will identify inflammatory diseases in the early stages, which are manifested by an increase in the number of leukocytes. This will allow you to prescribe the correct treatment in a timely manner and increase its effectiveness.

Smear during pregnancy

All women, regardless of whether they are in an “interesting situation” or not, are given the same smear for flora. The only difference is the frequency: pregnant women, accordingly, more often.

Even if the expectant mother is Lately was not sick, she could have contracted an infection and for a long time to be its bearer. And since the immune system is weakened during pregnancy, bacteria can begin to actively multiply at this time.

Smear tests before and after pregnancy can differ significantly. Even if no symptoms of the disease were observed before pregnancy, then with the onset of pregnancy, sexually transmitted diseases most often appear:

• gonorrhea;
• syphilis;
• ureaplasmosis;
• genital herpes;
• mycoplasmosis and others.

If a pregnant woman is a carrier of one of the sexually transmitted infections, then, most likely, leukocytes will be found in the smear, the norm of which is exceeded. If a pregnant woman has elevated leukocytes in a smear, the doctor should prescribe treatment. To establish an accurate diagnosis, a blood smear is also taken. This analysis is carried out on the same principle as the gynecological one. A blood smear can detect diseases such as malaria, typhus and others.

It is not uncommon for pregnant women to develop thrush, so the test may also show an increased amount of Candida fungus.

What should not be included in a smear test?

For normal functioning of the genital organs and wellness There must be a balance of good and bad bacteria in the body. A smear for the degree of purity may contain a small amount or not contain the following microorganisms and cellular structures:

• Atypical cells. May indicate a precancerous condition. They have an incorrect structure.
• Key cells. The key cells in the smear are epithelial cells “glued together” by gardnerella or other pathogens. Key cells in a smear can be observed in increased numbers with reduced immunity. In cases where a smear is examined for flora, this category includes squamous epithelial cells that are glued to infectious agents.
• Gardnerellas. These are small sticks in a smear. When examining vaginal smears, gardnerella may be present in small quantities. If a clean smear reveals an increased number of these bacteria, bacterial vaginosis. An increased number of them is also observed when vaginal dysbiosis.
• Candida. This fungus, like Gardnerella, is present in small quantities on the vaginal mucosa in healthy women. If the amount of candida fungus exceeds the number of lactobacilli, vaginal candidiasis develops (popular name - thrush). A gynecological smear confirms the disease in a latent form in the presence of spores, and in an active form in the presence of fungal threads. As a rule, the number of candida increases with reduced immunity, including during pregnancy.

Up to 40 different types of bacteria live in the vagina of a healthy woman. Bye total lactobacilli predominate, all bacteria, including candida and gardnerella, “peacefully” coexist.

• Cocci (gonococcus, staphylococcus and other cocci in the smear)

Cocci in a smear look like spherical bacteria. A smear for purity may contain several types of cocci, but only extracellularly. IN otherwise cocci indicate a venereal disease.

• Gonococcus. A gram-negative bacterium that multiplies when high humidity air. In addition to gonorrhea, cocci in a smear of this type of bacteria cause inflammation of the urethra, cervix, fallopian tubes, and rectum.
• Staphylococcus. The most common is Staphylococcus aureus, a gram-positive bacterium. 20% of the world's population are carriers of this type of coccus. Bacteria belonging to this genus of cocci in a smear cause mild skin infections (acne, etc.) and deadly diseases (pneumonia, osteomyelitis, endocarditis, etc.).
• Streptococcus. A gram-positive bacterium that lives in small numbers in the gastrointestinal (GI) and respiratory tracts, as well as in the nasal and oral cavities. If a pregnant woman has high levels of streptococci in her smear, they can cause miscarriage, early labor, and stillbirth. In addition, they cause diseases such as scarlet fever, bronchitis, tonsillitis, pharyngitis and others. In single quantities, streptococci in a smear may be normal.
• Enterococcus. A gram-positive bacterium that is part of the gastrointestinal microflora. Withstands heating up to 60 °C for half an hour. Such cocci in large quantities indicate inflammation of the genitourinary system, pelvic organs and other diseases.

• Trichomonas. A smear for infection does not always reveal Trichomonas, since this bacterium can have altered forms. To confirm its presence, bacteriological culture is done.

Your result is bad, does your vaginal smear contain pathogenic bacteria? Most infections are now successfully treated. The main thing is not to self-medicate and follow the doctor’s recommendations.

To maintain women's health and the possibility of timely detection of pathologies of the genital area, a woman should visit a gynecologist once every six months. During a routine examination, a flora smear is performed - the simplest and most painless diagnostic method. It allows you to determine the presence of many problems in the female body.

Taking a swab will take a few minutes. But preparing for such an analysis involves following certain rules that will help achieve effectiveness and reliability:

• 1-2 days before the test, do not have sex;
• do not use vaginal medications - creams, suppositories, tablets;
• do not take the test during menstruation;
• do not douche or take a bath.

Deciphering the smear for flora will enable the doctor to determine the presence of inflammatory processes, infectious diseases, fungal pathologies and hormonal imbalances. In addition, the polymorphic rod flora, which is determined by cytological examination of biomaterial, makes it possible to identify more serious diseases: tumors, metriosis and other pathologies.

A microflora smear (gynecological smear) is performed not only during a routine examination. It is mandatory for the following patient complaints:

• change in color of vaginal discharge;
• painful sensations in the lower abdomen outside of menstruation at rest or pain during sexual intercourse;
• itching and burning in the external genitalia;
• unpleasant odor of discharge, increased abundance, change in consistency.

During treatment, a smear analysis of the flora will make it possible to evaluate the effectiveness of therapy and, if necessary, make adjustments.

In the transcript of the flora smear, you can see the letter designations in which the analysis indicators are encrypted. A specialist can easily understand what this means.

And so, on the analysis form you can see:

• V, C and U - indicate the place from which a smear was taken for the flora of women. V-vagina – vagina, C-cervix – cervix, namely the cervical canal, U-uretra – urethra. Opposite these letters there will be indicators of the types of microflora that are found in them;
• L – leukocytes. They are present in any smear, but normal and pathological levels differ;
• Ep – epithelium. In some forms you can find the designation Pl.Ep. – flat epithelium, which is more accurate, since epithelial cells are flat;
• Gn – gonococcus, the causative agent of gonorrhea;
• Trich is a trichomonas, the causative agent of trichomoniasis.

In addition to these letter designations, the flora analysis contains indicators of the amount of mucus and Doderlein rods (lactomorphotypes). Their presence in large quantities indicates a healthy microflora.

In some transcripts accepted in certain laboratories, the microflora in the smear is indicated with a “+” sign. It has four positions: “+” - a small amount and up to “++++” - a significant amount. If certain indicators are missing, “abs” is given.

A vaginal smear undergoes a microscopic examination, as a result of which the doctor determines the degree of its purity. The gradation is carried out as follows:

• 1st degree - leukocytes within normal limits, microflora - mainly Doderlein bacilli and lactomorphotypes. The amount of mucus and epithelium is moderate. This analysis indicates the ideal condition of the genital organs, excellent local and general immunity, and the body’s ability to cope with inflammatory processes at their inception. Unfortunately, this degree of purity is extremely rare;
• 2nd degree: the number of leukocytes is normal, lactomorphotypes are presented along with other flora (coccal and yeast) in relatively equal quantities - mixed flora in the smear. Mucus and epithelium – moderate. This is no longer perfect option, however, is considered normal and does not require treatment. But still, the risk of developing inflammatory processes is higher, since local immunity is slightly weakened. This picture in a smear is much more common in women;

• Grade 3 – leukocytes are higher than the normal number, the rod flora in the smear is represented mainly by coccal and yeast species, lactomorphotypes are present in limited quantities. This analysis indicates the presence of an inflammatory process and the need for treatment;
• 4th degree - there are a lot of leukocytes, mucus and epithelium (there is such a medical designation as “entirely”). A polymorphic rod is observed in the smear - the microflora is represented by pathogenic bacteria, there are no lactomorphotypes. In this case, immediate treatment is required, since the inflammatory process is pronounced and can lead to complications.

The first two degrees of vaginal cleanliness are considered completely normal. At these degrees, various gynecological manipulations and surgical interventions are performed. The third and fourth require therapy, which will be based on the indicators of certain pathogenic agents.

Doderlein sticks

The presence of Doderlein bacilli in the flora smear indicates normality. After all, these large gram-positive rods are considered useful. Let's look at what they are and how they help the body.

Immediately after birth, the girl’s genitals are considered sterile, since there are no microflora in them. After some time, opportunistic microflora colonize, but the neutral pH environment does not allow them to develop.

During puberty, the body of a teenage girl begins to produce the hormone estrogen, which contributes to the formation of Doderlein bacilli (bacillary flora).

The rods feed on glycogen, which is produced by their own epithelial cells. Due to the transformation of glycogen, lactic acid is formed, which does not allow pathological microflora to develop in large quantities. After all, rod flora is normally represented by all types of bacteria. The main indicator is their number and balance between in different forms microorganisms.

The meaning of Doderlein sticks is as follows:

• maintaining an acidic environment, which prevents the development of pathological flora;
• selection of full-fledged spermatozoa that are “allowed” for fertilization;
• production of hydrogen peroxide, which keeps the vagina clean.

A female body in a healthy state regulates the amount of all the necessary beneficial sticks that fight harmful microflora.

Rods in a smear can be represented by small forms - cocci. These forms are separated into a separate group - coccal flora. Studying these rods under a microscope made it possible to name them that way. They have a cocoon shape, round in shape resembling a spiral or rod.

Their detection in a smear can mean both normal and pathological - it all depends on the number of coccal representatives and their type.

There are two types of cocci: gram-positive (Gr+) and gram-negative (Gr-). They are named after the scientist Gram, who was the first to study the possibility of identifying these bacteria by staining them.

• gram-positive cocci are a group of bacteria belonging to the opportunistic flora. This includes streptococci, enterococci and some others. The same Doderlein stick is included in this group. It is important to know that all these cocci can be present in certain quantities in a smear of a healthy woman. An excess of pathogenic forms indicates the need for treatment;
• Gram-negative cocci are pathogenic flora found only in a smear of a woman with pathologies and diseases. These include gonococcus, Escherichia coli and some others.

An important point in the treatment of any disease caused by an excess of coccal flora is the determination of positivity or negativity (Gr+ or Gr-).

Gram-positive forms respond better to treatment and the process goes faster than when fighting gram-negative pathogens. It's all about the permeability of the bacterial wall, which among the “negative heroes” is more resistant to internal penetration.

Acceptable levels

When deciphering a smear for flora, indicators that are within the range of accepted values ​​are considered normal. The presence of some representatives of the microflora, even in minimal quantities, may indicate the occurrence of pathological processes or serious diseases of the genitourinary area.

The table will make it possible to examine the picture in more detail.

At the planning stage of conception and during pregnancy, you need to especially carefully monitor the cleanliness of the vagina. This factor not only contributes to the desired pregnancy, but also protects the fetus while it is in the womb. With an increase in the number of certain representatives of opportunistic flora, complications are possible both during pregnancy and during childbirth.

In addition, there are certain indicators that will help to understand the cause of infertility associated with a violation of the microflora of the genital organs.

What does a smear tell you?

Using gynecological smear tests, you can identify pathology and undergo treatment on time. So what can misunderstood numbers and meanings tell us?

The following structures can be identified:

• an increase in the concentration of epithelium is evidence of the onset of the inflammatory process. The higher the indicator, the stronger the inflammation;
• the number of leukocytes within the reference values ​​is considered to be normal. If this indicator increases, then problems arise. The more leukocytes found in the smear, the higher the degree of the inflammatory process that accompanies acute or chronic pathologies of the woman’s genitourinary system;
• mucus in the smear may be present in small quantities in the vagina. An increase in its concentration indicates inflammatory processes. If mucus is found in the urethra, then this is evidence of inflammation of the bladder;

• coccal flora is permissible within the reference values ​​only in the vagina. Its presence in the urethra indicates the occurrence of dysbacteriosis and the passage of inflammatory processes;
• the presence of gonococci in the vagina indicates gonorrhea;
• the presence of Trichomonella and Gardnerella indicates the development of diseases caused by these rods;
• If a large number of yeast fungi is detected, a violation of the cleanliness of the vagina and the development of thrush are noted.

Using the analysis of a gynecological smear, specialists draw conclusions about the state of a woman’s immune system, the development of vaginal dysbiosis, the presence of infectious diseases and inflammatory processes of an acute and chronic nature. Also, using a smear, the doctor makes a conclusion about the effectiveness of the chosen method of treating the disease.

Having a smear test at least once every six months allows a woman to monitor her intimate health.

You need to visit a gynecologist once every six months. This will keep women’s health under control and identify diseases in time. The simplest and most accessible research method in gynecology is taking a gynecological smear.

Deciphering such an analysis will allow the doctor to see changes in the woman’s reproductive system that are not visible during an external examination.

• Taking a smear is a completely painless procedure and will only take a couple of minutes. It does not pose a health hazard and can be performed even on pregnant women.

When should you take a smear test?

Deciphering a smear analysis of flora can tell a gynecologist about the presence of sexually transmitted infections, an inflammatory process, and hormonal disorders in a woman’s body.

A flora smear (gynecological smear) is required if a woman has the following complaints:

1. Discharge of an unusual color from the genital tract.
2. Abdominal pain at rest or during sexual intercourse.
3. Feeling of itching and burning in the genital area.
4. The appearance of an unpleasant odor in the discharge.

Swabs are also taken during preventive examinations.

Interpretation of smear results

Using letters, the doctor marks the place where the smear was taken. Usually the letters of the Latin alphabet are used: V, C, U.

Smears are taken from three points: the vagina (V-vagina), cervix (C-cervix) and urethra (U-urethra).

In deciphering a smear for flora in women, you can find the strange word “cocci”. Cocci are microorganisms that have a round shape. This is a group of opportunistic organisms that are constantly present in the body.

However, they must be in a certain quantity. As soon as their number exceeds the permissible limit, cocci can cause unpleasant symptoms due to inflammation. In gynecology, this condition is called nonspecific colpitis.

Cocci are divided into two groups: gram-positive and gram-negative. This division has important diagnostic value in determining the pathogenicity of the microorganism that has settled in the vagina.

Coccus flora in a smear, gr.+ or gr.- cocci

The division of microbes into gram-negative and gram-positive appeared in microbiology after a Danish scientist named Gram discovered the ability of microorganisms to turn different colors, depending on the degree of their resistance to antibiotics.

When coloring the preparations, a special dark blue or purple. The scientist noticed that some microbes are stained Blue colour, and others are pink, although the dye is the same.

After careful research, it was found that microbes colored pink or crimson are less sensitive to antibiotics. In order for their death to occur, considerable efforts must be made.

Microorganisms that stained well in blue were called gram-positive (gram+), and those that remained pink were called gram-negative (gram-).

The pale coloration and resistance to antibacterial drugs was explained simply: these bacteria had a thicker shell. The structure of the wall is more complex than that of gram(+) cocci, which means that it is much more difficult for a dye or antibiotic to penetrate its layers.

This division is important for a gynecologist. Detection of gram(+) cocci in a smear is allowed. These microorganisms include staphylococcus and streptococcus, which can be present in the vagina of a healthy woman.

Gram(-) cocci can cause disease. The most common representatives of this group in gynecology are gonococci, the causative agents of gonorrhea.

What are Dederlein sticks?

An essential element of women's health is the rod flora in the vagina. Dederlein's rods are a generalized name that combines large and immobile gram-positive rods that provide normal microflora of the female genital organs.

They can be found under the name lactobacilli or gram-positive rods.

Dederlein's sticks play important role in a woman's life:

• They help maintain an acidic environment in the vagina, which ensures careful selection of sperm during fertilization.
• As you know, sperm do not live long in an acidic environment. Therefore, the first to die are the inferior, weakened male cells, which allows only the strongest and most resilient to reach the goal.
• Suppress the development of pathogenic microorganisms through the activation of macrophages.
• Hydrogen peroxide is released - helps to “maintain cleanliness” in the vagina.

In a smear of a healthy woman, Dederlein bacilli should be present in large quantities. A decrease in their number indicates possible problems with women's health.

What is Leptotrix in a smear?

Leptotrix belongs to opportunistic microorganisms. This is a gram(+) anaerobic bacillus that inhabits water bodies. Under a microscope, leptothrix has the appearance of a hair - a long and thin rod.

It is believed that leptothrix are not sexually transmitted, and their presence in a smear is not a cause for concern if no other abnormalities are detected.

The peculiarity of these bacteria is that they often accompany other pathogenic microorganisms - Trichomonas and Chlamydia. In this case, the doctor will prescribe medications to treat several pathogens at once.

If leptothrix is ​​detected during pregnancy planning, treatment is mandatory. It has been revealed that they can cause miscarriages, cause inflammatory processes in the membranes, and infect the child.

Smear standards for flora

After receiving test results, it can sometimes be very difficult to understand the numbers and letters written by the doctor. It's actually not that complicated. In order to understand whether you have gynecological diseases, you need to know the normal indicators when deciphering the smear analysis for flora. There are not many of them.

In smear tests in an adult woman, the normal indicators are as follows:

1. Flat epithelium (s.ep.) - normally its number should be within fifteen cells in the field of view. If the number is higher, then this is evidence of inflammatory diseases. If less is a sign of hormonal disorders.
2. Leukocytes (L) – These cells are allowed to be present as they help fight infection. The normal number of leukocytes in the vagina and urethra is no more than ten, and in the cervical area - up to thirty.
3. Dederlein sticks - a healthy woman should have a lot of them. A small number of lactobacilli indicates a disturbed vaginal microflora.
4. Mucus – should be present, but only in small quantities.

The presence of Candida fungi, small rods, gram(-) cocci, Trichomonas, gonococci and other microorganisms in the analysis results indicates the presence of a disease and requires a more in-depth study and treatment.

Table for deciphering the normal smear in women (flora)

Degrees of vaginal cleanliness

Often the doctor writes out a referral for a smear test for purity. Using this method, the “degree of cleanliness” of the vagina is determined. There are four of them in total. Only the first and second degrees are normal; the third and fourth degrees indicate the presence of diseases of the genital tract.

1st degree – an ideal option, which, unfortunately, is rare. Leukocytes in the smear do not exceed the permissible limits. The flora is represented by a large number of Dederlein bacilli, mucus and desquamated epithelial cells in small quantities.

2nd degree – The most common variant of the norm, in which leukocytes are within normal limits, mucus and epithelium are in moderate quantities. A small number of cocci or Candida fungi appear, and large quantities of lactobacilli appear.

3rd degree – a large amount of mucus and epithelial cells is detected in the smear. There are few beneficial lactobacilli; instead, there is an increased number of Candida fungi and pathogenic microbes.

4th degree – there are so many leukocytes that the doctor describes them as “entirely”. A very large number of pathogenic microorganisms. Dederlein rods are missing. Mucus and epithelium in large quantities.

The first and second degrees do not require treatment, but the last two degrees indicate an inflammatory process caused by one or another pathogen and require immediate treatment.

• Causes of increased leukocytes in a smear

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What smears can be taken?

Diseases of the female reproductive system are dealt with by a specialized branch of medicine - gynecology.

There are many reasons for patients to apply: undergoing a medical examination for employment, pregnancy, painful or unpleasant cramping sensations in the lower abdomen, itching or burning, thrush, heavy menstruation or discharge of unknown origin.

A general smear or microscopy is performed during a preventive examination or during pregnancy planning. The result is the study of the cervical and urethral canal, vagina, and in virgins - the rectum.

Papanicolaou cytology analysis makes it possible to timely detect the papilloma virus, precancerous conditions of the epithelium, and cervix. It is recommended that all females with hereditary cancer diseases and those over 21 years of age undergo a PAP test.

A bacteriological research method, bacterial culture in women, is recommended if there is a suspicion of an inflammatory process, a disorder of the microflora, which was caused by opportunistic and pathogenic microorganisms.

PCR is carried out in the form of an analysis for infections transmitted mainly through sexual contact. Provides complete information about the bacterial composition of the internal microflora.

The effectiveness and reliability of the method is 98%.

Preparing for a smear test

Before prescribing an examination, the gynecologist or laboratory employee is obliged to warn the patient about how to properly take a smear for flora, what can and cannot be done before the procedure.

Preparation for a microscopic examination involves avoiding strong antibiotics 2 weeks before the expected analysis and visiting the bathroom the day before. You should try not to go to the toilet 2 hours before the test.

It is better to do diagnostics not before, but during menstruation and in the first two days after.

To increase the sensitivity of the test, microflora culture is carried out in the absence of treatment with antibacterial drugs and douching. Be sure to follow a special diet 2-3 days before the bacteriological analysis: limit foods that provoke fermentation or intestinal upset.

Refrain from sexual intercourse with your partner and do not wash yourself 24 hours before data collection.

3-5 days before the prescribed PCR diagnosis, it is prohibited to take any antibacterial or contraception. It is necessary to avoid sexual intercourse for 36 hours. It is advisable not to shower the day before the PCR and on the eve of the test. The material is taken during menstruation and for 1-2 days after its end.

How to take a smear from women

The technique for collecting material is usually carried out in the morning in the gynecology department or directly in the laboratory itself. Taking vaginal discharge and areas for examination is prescribed only for women who are sexually active. In girls, it is taken more carefully from the lateral vault of the vagina to prevent damage to the hymen, and from the intestines, secretion.

All manipulations take place on a gynecological chair. At this time, the specialist introduces a special mirror depending on age and physiological characteristics patients. If the organs are not yet formed, size XS is used, girls will need a mirror S. After labor, examination instruments with a diameter of 25-30 mm, sizes M, L are used.

The material is collected with a spatula or spatula, brush, applied to a glass slide or placed in a test tube for further transfer of the results to the laboratory.

Microflora smear: interpretation

It is impossible to independently draw a conclusion about how good or bad a smear is without the appropriate knowledge. Using special notations, it is very easy to decipher a microscopic examination of a smear. Depending on the location of the biological material taken, they are distinguished: vagina - “V”, cervix - “C” and urethra - “U”.

Gram-positive rods, “Gr.+” and the absence of coccal flora. The result is “++++”. It is observed quite rarely, most often it is a consequence of intensive antibacterial therapy. Norm: “++”, “+++” rods, the number of cocci does not exceed “++”.

Gram-negative bacteria gonococci - “Gn”, trichomonas vaginalis - “Trich”, yeast of the genus “Candida”. Corresponds to diseases such as gonorrhea, trichomoniasis and candidiasis.

The presence of key cells and E. coli, if they are listed in the microflora, indicates that the patient has bacterial vaginosis.

Flora smear: normal in women

All patients, without exception, from the age of 14 until the onset of menopause, correspond to the same standard, obtained as a result of laboratory microscopic examination.

Leukocytes. Providing protection for the body from penetrating viruses, bacteria and infections, they can be in the field of view, but should not exceed the indicator in the vagina - 10, in the cervix - 30, urethra - 5.

Epithelium. A moderate amount of epithelial tissue is normal. A high number indicates possible inflammation, while a too low number indicates insufficient production of the hormone estrogen.

Slime. A small amount or no quantity is allowed. The maximum daily rate of secretion from the glands of the cervical canal is 5 ml.

Gram-positive rods, “Gr.+”. Lactobacilli and Doderlein bacilli must be present in large quantities. They are responsible for the body's immune response to foreign bodies. They should not be in the cervix and urethra.

“Gr.-”, gram-negative, anaerobic rods are not detected.

Gonococci with the symbol “gn”, Trichomonas, chlamydia, key and atypical cells, fungi, yeast, Candida are absent. If they are detected in the results, the patient is prescribed additional testing for gonorrhea, trichomoniasis, chlamydia, bacterial vaginosis, and thrush.

Smear for purity level

To avoid complications during pregnancy, pregnant women are advised to determine the degree of purity of the gynecological smear. Normally, in a healthy woman, 95-98% of the vaginal microflora consists of Bacillus vaginalis or Lactobacillus bacillus Doderlein. They produce lactic acid, which helps maintain acidity levels.

Pathogenic and opportunistic microorganisms are not able to survive in such conditions. But under the influence various factors, such as sexual activity, menopause, the menstrual cycle and decreased immunity, microflora indicators may change.

• 1st degree Normal vaginal cleanliness is pH 3.8-4.5. The environment is acidic. Leukocytes and epithelial cells - no more than 10.
• 2nd degree. Slightly acidic environment: pH=4.5-5. There is a slight increase in gram-positive cocci and Candida fungi.
• 3rd degree. Pathogenic microorganisms are activated, mucus appears, and epithelial indicators exceed the norm. Neutral acidity level, pH=5-7. There are over 10 leukocytes. Mucus, key cells are present, gram-negative and gram-positive microorganisms multiply in favorable microflora conditions.
• On the last one, 4 degrees, cleanliness is low. pH values ​​reach 7.5. Doderlein's rods are either completely absent or found in single quantities. The vagina is filled with pathogens.

Bacteriological research

The variety of composition, in addition to Lactobacillus bacillus Doderlein, which is an integral part of the vaginal microflora of the woman being examined, does not begin to be studied immediately. Sowing the collected biological material onto a specially created favorable environment for its subsequent growth, development and reproduction takes time.

Bacteriological culture of flora can be assessed through a microscope, provided that the number of representatives of microorganisms increases.

• 0 class. Observed during treatment with antibiotics. The pathogen is absent.
• I class. The number of bacteria does not increase or increases moderately.
• II class. Mixed nature of microflora. Up to 10 colonies of bacteria Gardnerella vaginalis or Mobiluncus, the causative agents of gardnerellosis, are detected.
• III class. There are about 100 colonies. The microflora is predominantly inhabited by Gardnerella and Mobiluncus. Symptoms of bacterial vaginosis appear.
• IV class. Lactobacilli are absent, immunity is weakened. Diagnosis of acquired infectious disease - aerobic vaginitis.

Cytological examination

The probability of detecting areas of altered epithelium, papilloma virus and oncological tumors is quite high after 30 years of age and the beginning of sexual activity.

The correct interpretation of the PAP test depends on the presence or absence of cancerous, atypical cells.

• NILM. The clinical picture is without features, CBO. Leukocytes and bacteria are released in small quantities. Primary candidiasis or bacterial vaginosis is possible. The epithelial layer is normal.
• ASC-US. Atypical areas of unknown origin were found in epithelial tissue. A repeat analysis is carried out after 6 months to look for chlamydia, dysplasia, and human papillomavirus.
• LSIL. To confirm a precancerous condition caused by atypical cells, a biopsy and colposcopy are prescribed. Weak signs of changes in the epithelium.
• ASC-H. Pronounced damage to the squamous epithelium. 1% of patients are diagnosed with the initial stage of cervical cancer, the remaining 98-99% have grade 2-3 dysplasia.
• HSIL. Concomitant symptoms preceding cancer of the squamous epithelium and cervix were identified in more than 7% of the women examined. 2% have cancer.
• AGC. Atypical condition of the glandular epithelium. Diagnosis: cervical or endometrial cancer, advanced form of dysplasia.
• AIS. Squamous cell carcinoma, cervical cancer.

PCR analysis

The molecular biological method of PCR diagnostics is distinguished by its high sensitivity and reliability of the data obtained. By creating earlier samples of the isolated and copied DNA section, comparisons are made with the resulting biological material.

Testing for infections using PCR makes it possible to quickly find the causative agent of a disease in the female genital organs by obtaining a positive or negative result.

The polymerase chain reaction facilitates the determination of chlamydia, ureaplasmosis, thrush, trichomoniasis, HPV, HIV, and the search for the causes of difficult pregnancy and hormonal disorders.

The disadvantages of PCR are cases of false data due to incorrect tests and possible mutation of the pathogen's DNA.

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What do these letters mean?

In the results of a smear on the flora, you may notice Latin or Russian letters. It’s not difficult to guess that each of these letters has its own decoding:

"V" is vagina, vagina. The numbers opposite this letter show what was found in the smear from the vaginal mucosa.

"C" is cervix, Cervix. The numbers next to this letter tell the gynecologist about the findings in the cervical smear. All deviations from the norm next to the letter “C” indicate changes in the cervix.

"U" is urethra, urethra. All symbols opposite this letter tell the gynecologist about changes in the urethra.

"L" is leukocytes. Very often, to save space and time, laboratory assistants write the Latin letter “L” instead of the long word “leu-co-cyt”.

"Ep" is short for epithelium. Sometimes laboratory technicians indicate the more complete name of this tissue: squamous epithelium (or abbreviated as “pl. ep.”)

"abs" is an abbreviation of the Latin word that means absence of something. For example, if “abs” appears opposite the Gonococcia column, this means that no gonococci were detected, that is, you do not have gonorrhea.

“gn” is the designation for gonococci, the causative agent of gonorrhea. Some laboratories simply write “gonococci” or “Neisseria gonorrhoeae”, while others use the short Latin designation “gn”.

“trich” is a neighbor of the previous abbreviation; almost always, as a result of the stroke, these two columns go next to each other. The abbreviation "trich" means the bacterium "Trichomonas vaginalis", the causative agent of trichomoniasis.

What is coccal flora?

Cocci are round-shaped bacteria that can be found normally. However, a large number of cocci (abundant coccal flora) is a sign of decreased immunity and indicates the beginning of inflammation of the mucous membranes of the vagina, cervix or urtera (depending on which letter next to which there is an entry about abundant coccal flora). Sometimes, instead of the words “coccal flora”, the smear results simply indicate “cocci”.

What is gr.+ or gr.- cocci?

These letters indicate whether the bacteria belong to a particular group of microorganisms. Gram-positive (gr.+) and gram-negative (gr.-) cocci are treated differently, as they have different structures. Thus, this designation helps the gynecologist in choosing a medicine.

Gr.+ (gram-positive) means that these cocci are most likely streptococci or staphylococci. Gr.- (gram-negative) cocci are most likely the bacteria that cause gonorrhea. These cocci may also be referred to in the assay as gonococci (“gn”).

What is Leptotrix?

Leptothrix is ​​a bacterium that can be found in some women's smears. The presence of Leptotrix is ​​not yet a disease, but it indicates a disturbance in the composition of the vaginal microflora, or some sexually transmitted diseases. That is, leptotrichia itself is not sexually transmitted, but can appear in a smear if a woman has chlamydia, trichomoniasis or other infections.

Leptothrix is ​​sometimes seen as a sign of bacterial vaginosis or thrush. That is, to clarify the diagnosis, your gynecologist may prescribe additional tests (culture, PCR, etc.)

What are the norms for a smear on the flora?

Below are the norms for a smear on the flora for girls over 14 years old and women under 45-50 years old. In girls under 14 years of age and in women after menopause, smear standards are different.

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To increase the information content of analysis results, certain conditions must be met:

• a couple of days before the study, refuse sexual intercourse;
• do not use vaginal suppositories, lubricants and other means, do not douche and limit yourself to taking a shower, refusing baths;
• To visit a gynecologist, choose a period of the menstrual cycle when there is no bleeding.

On the day of visiting the gynecologist, the external genitalia are washed with soap, other detergents are excluded. It is not recommended to urinate for 2-3 hours before taking the test.

A smear of flora is taken with sterile instruments (spatula, forceps or tweezers) from three places: the cervical canal, the vaginal walls and the urethra.

The procedure for taking smears is one of the medical procedures performed by a gynecologist; as a rule, it is absolutely painless. It also allows you to monitor the implementation of therapeutic therapy.

Gynecological smear for flora: norm and deviations from it

95% of the contents of the vaginal flora of a healthy woman are lactobacilli, the main function of which is the production of lactic acid, which is necessary to maintain the required acidity, protecting the genitourinary organs of women from the penetration of infectious agents.

It is especially important to do a smear on the flora for pregnant women, since during pregnancy the number of lactobacilli decreases, which reduces the body’s natural defenses and, as a result, leads to frequent infections.

Normally, the microflora of the genitourinary system, in addition to lactobacilli, contains a small amount of other microorganisms, such as gardnerella and candida. Due to a decrease in immune defense, which is caused by fatigue, emotional stress, pregnancy or various diseases, gardnerella and candida can accelerate their reproduction, which will lead to gardnerellosis and candidiasis. This is how informative a gynecological smear is.

Normal indicators in a smear in an adult woman will be the following:

1. The number of squamous epithelium should be 15 cells per field of view. An increase in this number indicates inflammation. A decrease indicates hormonal imbalances.
2. The presence of white blood cells in a smear is normal because it indicates that the body is fighting infections. But there should be no more than 10 in the vagina and urethra and no more than 30 in the cervix.
3. A woman's smear should contain Dederlein bacilli, and in large quantities. If there are few of these lactobacilli, then most likely the microflora is disturbed.
4. A small amount of mucus in the smear is acceptable.

If the tests contain Candida fungi, small bacilli, cocci, trichomonas, gonococci, then most likely there is a disease. Then the investigation must be deeper and treatment may be required.

Deciphering a smear for flora

Medical workers have introduced a system of abbreviations and use letters of the Latin alphabet to indicate analysis indicators.

For example, the sites for smear collection are designated as follows:

• V - vagina - translated from Latin as “vagina”.
• U - urethra - urethra.
• C for cervix - cervical canal.
• L - leukocytes are the so-called white blood cells; their increase indicates the presence of an inflammatory process.
• Gn - gonococcus.
• "Pl. Ep." - flat epithelium.
• Trich - Trichomonas.

The presence of mucus in a smear is an important indicator of the pH of the vaginal environment. But this is not the whole decoding of the smear.

The amount of a particular flora is indicated by a “+” sign.

• “+”—the amount of the indicator is insignificant;
• “++”—the amount of the indicator is moderate;
• “+++”—increased amount of indicator;
• “++++” is an overestimated (abundant) amount.
• “abs” - “absence” - is written when any of the indicators is absent.

What is coccal flora in a smear?

Ball-shaped bacteria are called cocci. Normally, single cocci are found in smears. With a decrease in immunity, the amount of coccobacillary flora in smears increases. Cocci are divided into gr+ (positive) and gr- (negative). Let's look at their differences.

In microbiology, for a detailed description of bacteria, in addition to indicating their shapes, sizes and other characteristics, there is also the “Gram stain” method. The smears are exposed to a special staining agent. Microorganisms that remain colored after washing the smear are called gram-positive (gr+), while those that become discolored during washing are called gram-negative (gr-). The most common gram-positive microorganisms include, for example, staphylococci, streptococci, enterococci, and lactobacilli. Proteus, gonococci and Escherichia coli are gram-negative.

How is a smear examination performed on a pregnant woman?

During this period, she produces a large amount of the hormone progesterone, which promotes an increase in lactobacilli (sometimes up to 10 times). Thus, nature itself protects the unborn child from various infections. Therefore, when planning a child, it is very important to make sure that there are no inflammatory processes in the vagina.

When registering for pregnancy, a smear is taken from all women for flora. To assess the state of microflora in gynecology, the term “degree of vaginal cleanliness” is used. The woman must know and monitor it throughout her pregnancy; for this, at 30 and 38 weeks, a second smear is done on the flora.

Degrees of vaginal cleanliness

Gynecologists distinguish four degrees of vaginal cleanliness:

• Degree 1 - the woman is absolutely healthy. The microflora is represented by 95% lactobacilli; the presence of single epithelial cells and leukocytes is possible.
• At the 2nd degree of purity, opportunistic microorganisms may be found in small quantities in the smear.
• The 3rd degree of purity is characterized by a greater number of opportunistic microorganisms than Doderlein bacilli.
• 4th degree of purity: the smear contains a lot of leukocytes, epithelium and other bacterial flora. There are few or no lactobacilli.

The 1st and 2nd degrees of purity are characterized by a pronounced acidic environment, and at 3-4 the pH shifts and becomes alkaline.

Analysis of a gynecological smear allows you to more clearly diagnose diseases and correctly build a line of treatment.

For example, an increased number of leukocytes and epithelium becomes a sign of an acute or chronic inflammatory process. The discovery of mucus in the urethra, which does not normally exist, may indicate inflammation of the canals of the urinary system.

The presence of a large number of cocci in the smear also indicates the presence of inflammation of the genital organs and decreased vaginal cleanliness. Normally, there is no coccal flora in the urethra, and only a single amount is allowed in the vagina.

If gonococcus is detected in the smear, the patient is diagnosed with gonorrhea. The presence of gardnerella and trichomonas indicates the presence of gardnerellosis and trichomoniasis in a woman. A change in the degree of purity and dysbiosis is also evidenced by an increase in the number of fungi of the genus Candida, which, as a rule, is accompanied by a small number of Doderlein bacilli.

Considering all of the above, we can say that microscopy of a gynecological smear indicates the state of the immune system and is an important marker in diagnosing the condition of the genitourinary system and its chronic infections.

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Flora smear in women - what it shows

In gynecology, one of the most informative diagnostic methods is a smear test for flora. Material for analysis is taken from the mucous membrane of three areas: urethra, vagina, cervix. Such diagnostics give doctors the opportunity to determine the quantitative and qualitative composition of the microflora of the genitourinary tract, the presence of an inflammatory process and the presence of atypical cells. With the help of a smear on the flora in women, the causative agents of various sexually transmitted infectious diseases can be easily identified.

In what cases is a smear analysis for flora carried out?

This study is always performed when a woman complains of any symptoms associated with gynecological diseases (pain in the lower abdomen, itching and discomfort in the vagina, changes in the nature of discharge). Also, smear analysis should be carried out as part of preventive examinations. In addition, a smear is taken when planning pregnancy and after finishing antibacterial therapy.

How many days does it take to prepare a smear test for flora?

Women have a question: how long does it take to analyze a smear for flora? It will be ready within 1 day.

How long are flora smear tests valid?

The analysis result is valid for 10 days.

How to properly take a smear for flora

Preparing to take a smear for flora

Special preparation for a smear on the flora in women is not required. There are just a few things to pay attention to. For two days before the test, a woman should not use any vaginal products, including suppositories and lubricants. Also, for 3 days you should refrain from sexual contact, bathing, and douching. Please remember that the procedure cannot be performed during menstruation.

How to take a smear for flora in women

On the day of taking the material for analysis, nothing other than regular washing with warm water without soap should be used for vaginal hygiene. Two hours before the procedure, urination is not recommended. The gynecologist first examines the walls of the vagina and cervix using mirrors, then, using a special spatula or cotton swab, takes material from 2 areas - the vagina and cervix, and then from the urethra. The resulting material is applied to 3 sterile slides with marks: V (vaginal smear), C (cervical smear), U (urethral smear). The gynecologist dries the glasses and sends them for examination to the laboratory, where the smears are stained and determined which microflora is present.

This procedure of taking a smear on the flora is completely painless, passes quickly and does not entail any complications. The only thing that may be unpleasant sensations is when they take a smear from the inflamed opening of the urethra.

Taking a smear from a virgin

A smear of the flora from virgins is taken in the same way, through a hole in the hymen. The girl does not experience any painful sensations, and the hymen is not injured or torn. A smear on the flora can be taken even from little girls, if there is an indication for this.

Flora smear - norm and pathology

In women who do not have gynecological problems, the content of lactobacilli in the smear should reach 95%. Lactobacilli produce lactic acid, which helps maintain sufficient acidity. This protects the woman’s genitals from penetration of pathogenic microorganisms.

It is known that during pregnancy the number of lactobacilli may decrease. Therefore, the natural defense mechanism is disrupted, which leads to the risk of infection. This is why flora smear analysis during pregnancy is very important for expectant mothers.

Lactobacilli are not the only type of microorganisms that make up the microflora of a healthy woman. Normally, candida and gardnerella may also be present. But their number should be very small. Under the influence of certain factors (prolonged stress, overwork, pregnancy, illness), the body's immune defense weakens. Under such conditions, these organisms multiply rapidly, and vaginal dysbiosis (bacterial vaginosis), candidiasis (thrush), gonorrhea, chlamydia, ureaplasmosis, mycoplasmosis and gardenerellosis develop.

Flora smear (table of norms)

You are presented with a table of smear norms for flora, in which it is very easy to find the desired indicator.

Flora smear: deciphering indicators

In order to save time in medical practice Abbreviations are used to indicate smear test results. The Latin letters V, C, U usually denote the areas from which material for analysis is taken.

V – vagina (in Latin vagina).
C – cervical canal (cervix).
U – urethra.

In addition, the following designations are used to decipher smear analysis in gynecology:

L – leukocytes. These cells are present in both healthy women and patients. If there is a disease, the number of white blood cells increases.

Ep – epithelium. The designation “pl. ep." This means "squamous epithelium".

Trich – Trichomonas. This is the organism that causes a disease called trichomoniasis.

Gn – gonococcus, which is the causative agent of gonorrhea.

In addition, smears often contain mucus. This indicates that the vaginal pH is within normal limits.

+ - small amount.
++ - moderate.
+++ - increased.
++++ - big.

If any organism is not detected at all, a mark is made “abs”, which means “absent”.

Doderlein sticks in a smear

This is the second name for lactobacilli, organisms that form the natural flora of the vagina. These bacteria produce lactic acid, which maintains the acidity necessary to neutralize pathogens.

A decrease in the number of lactobacilli indicates that the vaginal pH is shifting to alkaline values ​​and becomes less than 4.5. This often happens during active sexual life. It should be noted that the pH of the vagina largely depends on the presence of opportunistic as well as pathogenic organisms. Moreover, the presence of a certain number of opportunistic forms in the vagina is considered normal.

Cocci are spherical microorganisms. These bacteria are found in both healthy women and those who suffer from inflammatory diseases. The presence of a few cocci in the smear is considered normal. When immunity weakens, the number of cocci begins to increase sharply. They can be gram-positive and gram-negative.

What is the difference between gr+ and gr- cocci?

To describe microorganisms in detail, experts not only indicate their size and shape. Gram staining is necessary for complete characterization. Some microorganisms will be colored after washing the material. These are the gram-positive forms. Other organisms become discolored as a result of washing, that is, they are gram-negative bacteria.

Gram-positive bacteria include staphylococci, streptococci, and enterococci. Gram-negative cocci include Escherichia coli, gonococci, and Proteus.

To clarify the diagnosis, it may be necessary to take a smear for culture.

Epithelium in a smear for flora

Epithelial cells may normally be present in a smear for flora. These cells represent the outer layer of the vaginal wall and cervix. Their number may vary depending on the phase of the menstrual cycle, hormone intake, and during pregnancy. If the body has a lot of sex hormones - estrogens, then there will be a lot of epithelial cells. If the epithelium is absent, this indicates epithelial atrophy, a lack of estrogen or an excess of male sex hormones.

Key cells in a smear in women

Key cells are epithelial cells surrounded by small rods. Normally they shouldn't exist. And with pathology, they are found in the smear, this indicates that aerobic lactobacilli have been replaced by anaerobic microorganisms, including small rods. This condition is called bacterial vaginosis.

Mushrooms in a smear

Fungi may be present in small quantities and not cause symptoms of the disease. This is the case if fungal spores are found under a microscope, if hyphae and fungal mycelium are found, then there will be widespread candidiasis with vivid symptoms.

Trichomonas are large single-celled organisms with flagella. Under a microscope you can find
whole or destroyed microorganisms. This indicates a trichomoniasis infection.

Trichomonas are shown by arrows

The norm of leukocytes in a smear for flora

Normally, the number of leukocytes in a smear for flora in the first phase of the menstrual cycle is up to 10 per field of view, in the second phase - 10-15 per field of view. If the leukocytes in the smear are elevated, this indicates an inflammatory process, but does not identify the pathogen.
And therefore, if nothing else is found other than an increase in white blood cells, then a more sensitive culture test or PCR diagnostics may be required to detect smaller pathogens: viruses, mycoplasmas and chlamydia.

Table of norms for the content of microorganisms in a smear

The body of pregnant women begins to produce a lot of progesterone, which is why the number of lactobacilli increases several times. This is necessary to protect the developing fetus from pathogens. Therefore, it is advisable to undergo an analysis of the degree of vaginal cleanliness at the stage of pregnancy planning.

In pregnant women, flora smears are taken repeatedly. The first time a woman registers, then at 30 and 38 weeks. In this way, vaginal microflora is monitored throughout the entire period of pregnancy. Pregnant women often experience vaginal candidiasis due to hormonal imbalances. If “strange” discharge appears during pregnancy, you should definitely contact your treating gynecologist.

Degrees of vaginal cleanliness

To assess the state of the microflora, the concept of “degree of vaginal cleanliness” is used.

The first degree of vaginal cleanliness - this indicator indicates that the woman is completely healthy. The content of lactobacilli in the smear in this case reaches the norm of 95%. Single squamous epithelial cells may be present, and the vaginal pH is acidic. Pathogenic microorganisms and leukocytes are absent.

With the second degree of vaginal cleanliness, the smear reveals 80-95% lactobacilli and a small number of opportunistic microorganisms, as well as single epithelial cells (no more than 5) and leukocytes (no more than 10) and epithelial cells, the pH of the vagina is acidic. The second degree is typical for most healthy women and, like the first, is considered the norm.

With the third degree of vaginal cleanliness, the smear contains more opportunistic microorganisms than lactobacilli, and this indicates the presence of an inflammatory process, the pH of the vagina is alkaline or neutral. The smear reveals leukocytes (10 – 30) and epithelial cells. A woman may be bothered by pathological discharge, itching and burning in an intimate place.

The fourth degree of vaginal purity - this means that the analysis revealed a lot of pathogenic bacterial flora, leukocytes (more than 50) and epithelial cells (more than 15 - 20) with a small number of Doderlein rods, the vaginal environment is strongly shifted to the alkaline side. In some patients, lactobacilli are not detected at all. This condition indicates the development of bacterial vaginosis or another infectious and inflammatory disease. The woman has clear symptoms of an infectious disease.

For the third and fourth degree of vaginal cleanliness, it is required drug treatment using antibiotics wide range actions. Antibacterial therapy is prescribed taking into account the sensitivity of pathogenic microorganisms.

Interpretation of smear results for flora in women

What do the results of the smear analysis indicate? The presence of certain components in a smear makes it possible to suggest a certain disease, choose further diagnostic methods and prescribe the correct treatment.

If the content of leukocytes and epithelium is high, there is reason to suspect an inflammatory process (acute or chronic). In healthy women, mucus is present only in the vagina. Its detection in the urethra is a sign of inflammation in the urinary system. There should also be no cocci in the urethra. If the smear test is “bad,” additional urine tests and ultrasound will be required.

If the smear contains cocci, small rods and “key” cells, the gynecologist diagnoses bacterial vaginosis.

When gonococcus is detected, a diagnosis of gonorrhea is made. If gardnerella and trichomonas are detected, then the patient has gardnerellosis and trichomoniasis. A large number of Candida fungi indicates a deterioration in the degree of purity and dysbiosis. In this case, the number of Doderlein bacilli usually becomes smaller compared to pathogenic ones, and the doctor diagnoses vaginal candidiasis.

conclusions

The results of a smear analysis of the flora in women during a preventive examination make it possible to assess the functioning of the immune and hormonal systems, identify vaginal dysbiosis, diagnose chronic inflammatory diseases of the genitourinary organs and sexually transmitted infectious diseases. If the flora smear is “bad,” the gynecologist can promptly prescribe additional examination methods and select the required treatment.
A “good” smear on the flora will give a woman peace of mind and confidence that everything is in order regarding her women’s health, which is why it is so important to undergo a gynecological examination once every six months.

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Types of smears in gynecology

Laboratory tests in gynecology are mandatory and additional: for preventive and diagnostic purposes, a smear is required, and if necessary, more detailed studies are prescribed, such as cytology and bacterial culture.

Bacterioscopy

Taking a smear on the flora is also called a bacterioscopy or a general smear. Deciphering such an analysis makes it possible to determine:

• composition of the microflora of the vagina, cervix and urethra;
• the presence of pathogenic microorganisms (gonococci, trichomonas and fungi);
• localization and intensity of the inflammatory process in the genitals.

Bacterial culture

This is a laboratory analysis of the genital organs, in which biological material is placed in a nutrient medium in order to grow and study pathogenic bacteria. After laboratory testing, a conclusion is made about the type of pathogens and their susceptibility to antibiotics.

Bacterial culture is prescribed after receiving a smear, in cases where coccus bacilli and other pathogenic microorganisms are detected. Bacterial culture is also carried out for frequent inflammation of the urinary tract.

Cytology

Cytology tests in gynecology are a laboratory study of the epithelium of the internal genital organs.

Scrapings for cytology are prescribed in two cases: to study hormonal disorders and for oncological tests.

In case of hormonal disorders in a woman’s body (for example, amenorrhea), smears are taken 5-6 times throughout the entire menstrual cycle. Based on changes in the epithelium, conclusions are drawn about the hormonal function of the ovaries.

If there is a suspicion of oncological processes with severe erosion, a scraping is performed from the cervix.

When to take a smear for flora

Taking a gynecological smear is a mandatory procedure when visiting a antenatal clinic. Using this procedure, changes in the bacterial environment of the vagina and urethra, which can lead to pathological processes, are monitored.

A gynecological smear is most informative for the following symptoms:

• itching and discomfort;
• discomfort after sexual intercourse;
• pain during and after urination;
• unusual discharge;
• unpleasant odor;
• lower abdominal pain.

A gynecological smear on the flora makes it possible to diagnose the following diseases:

• thrush or vaginal candidiasis;
• bacterial vaginosis, or dysbacteriosis;
• tyrchomoniasis;
• gonorrhea.

Microflora analysis must be carried out once a year, during a medical examination. If a bacterial infection or inflammatory process is detected in the test results, the test is repeated after a course of treatment.

How to properly prepare for analysis

In order for the analysis to be most informative, it is necessary to adhere to a number of rules before the procedure:

• the procedure cannot be performed during menstruation;
• abstain from sexual intercourse for 48 hours;
• after 2 days of scraping, you cannot douche;
• do not use vaginal suppositories on the eve of a smear;
• do not take a bath;
• exclude the use of any intimate hygiene products for several days;
• 3 hours before taking a scraping, you should avoid going to the toilet.

These precautions are necessary to ensure that the flora is as natural as possible on the day of the procedure, which will allow one to assess the number of opportunistic and beneficial microorganisms.

How to take a smear

The scraping procedure is painless, is carried out using a gynecological speculum with an expander and takes 2-3 minutes.

Using a special disposable brush, the gynecologist takes biological material in three places: from the urethra, vagina and cervix. Next, the smears are examined in the laboratory.

In the results, when deciphering the analysis of a smear for flora, the Latin letters are indicated, which indicate the place where the smear was taken:

• Vag (V) – vagina;
• Ur (U) – urethra or urethra;
• Cer (C) – cervix.

Decoding the smear norm for flora in women (table)

Interpretation of a smear for flora in women includes the following data: epithelial indicators, mucus assessment, the presence of gonococci, Trichomonas and Candida fungi, as well as an assessment of the number of Dederlein bacilli.

Leukocytes- These are the formed elements of blood that can protect the body from viruses and bacteria. If the level of leukocytes increases, this indicates inflammatory processes in the genital or urinary organs.

If the leukocytes in the smear exceed the permissible norms, this may indicate inflammation of the mucous membrane of the vagina (colpitis), uterus (endometritis), and uterine appendages (adnexitis). It is also possible to increase the number of white blood cells in the urethra due to inflammation of the urethra (urethritis).

Epithelium. The internal genital organs of a healthy woman are covered with a thin layer of epithelial cells. If the amount of epithelium exceeds the norm, this indicates hormonal imbalances.

In this case, the desquamation of the internal mucous membrane is disrupted, and several balls of epithelial cells are formed one on top of the other. In case of increased levels of epithelium in the flora smear, a cytological examination is prescribed.

Slime is the result of the secretion of glands of the cervical canal. Largest quantity mucus is concentrated on the cervix, which facilitates the penetration of sperm. The absence of mucus indicates a malfunction of the uterine glands.

Finding mucus in the urethra may be a sign of inflammation of the urinary system, since normally there is no mucus in the urethra.

Gonococci(coccus rods) are bacteria that cause gonorrhea (a sexually transmitted disease). The presence of gonococci in the genitals requires mandatory treatment.

Trichomonas are the causative agent of trichomoniasis. One of the signs of the disease may be small ulcers in the vagina, which can be detected during examination. In most cases, when pathogenic bacteria are identified in the flora, several types of microorganisms are detected at once.

Key cells. In gynecology, epithelial cells that are changed due to the influence of pathogenic bacteria, fungi or microflora disorders are called key cells. The presence of key cells in the smear indicates thrush or dysbacteriosis.

Candida fungi(Candida) are pathogenic fungi that are always present in the human body and, at the same time, their presence is not indicated in the smear transcript.

Microflora. The composition of normal microflora in a woman’s reproductive system is quite diverse. 90-95% beneficial bacteria- These are lactobacilli Lactobacillus (or Dederlein sticks).

Lactobacilli produce special lactic acid, which reduces the pH of the vagina to 3.8-4.2. Increased acidity is necessary so that weak and slow sperm cannot fertilize the egg. Also, Dederline sticks produce hydrogen peroxide, which serves to protect the uterus from pathogenic microorganisms.

The normal microflora also includes some opportunistic microorganisms (mycoplasma, gardnerella, streptococci, ureplasma, staphylococcus). These microorganisms in a smear of a healthy woman are found in small quantities (1-2% of the microflora) and do not require treatment, since pathogenic bacilli are controlled by lactobacilli and the woman’s immune system.

The vaginal flora is unstable and depends on the phase of a woman’s menstrual cycle. In the first half of the cycle, especially during menstruation, the number of Dederlein bacilli decreases, as a result of which acidity changes, as well as susceptibility to pathogenic microorganisms.

A few days before ovulation, Dederline bacilli multiply as much as possible, protecting the genitals from pathogenic bacteria and fungi.

Flora smear during pregnancy

The test results for a pregnant woman are practically no different from the normal values. The vaginal flora in pregnant women consists of more Dederlein rods, the occurrence of which is due to the influence of the following factors:

• absence of critical days;
• the need for enhanced protection of the internal genital organs (including the fetus) from the penetration of pathogenic microorganisms.

To identify pathogenic bacteria in pregnant women, smears are taken several times during pregnancy. The procedure is carried out in order to exclude the development of diseases caused by gonococci, staphylococci and trichomonas, since infections can lead to miscarriage or infection of the child.

Based on data on the state of the microflora, a conclusion is made about the degree of cleanliness of the vagina. In this case, cleanliness refers to the high level of Dederline bacilli and the absence of pathogenic microorganisms in the vagina of healthy women. There are 4 degrees of purity.

• Normocenosis or 1st degree of purity. A smear from a healthy woman contains normal epithelium and a large number of Dederlein rods. The acid-base balance is normal, acidic environment (ph - 3.8-4.2).
• Carrier status or 2nd degree of purity. The scraping reveals a small amount of opportunistic microorganisms, leukocytes are within normal limits, but the pH remains slightly acidic.
• Dysbiosis or bacterial vaginosis. Smear analysis shows the majority of coccus rods, key cells, leukocytes and fungi. Beneficial lactobacilli are found in insufficient quantities. Ph changes to a slightly alkaline reaction and is represented by indicators of 5.0 – 5.5.
• At the fourth degree of purity, lactobacilli are not observed in the results. Only pathogenic microorganisms are found in the microflora (coccal flora, key cells, Trichomonas and many leukocytes). The vaginal environment becomes alkaline (ph 6.0-6.5).

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Normal vaginal microflora

A healthy woman's vagina is not sterile. It contains many types of microorganisms, their totality is called microflora. Bacteria constantly compete with each other for habitat on the walls of the vagina and for food.

The most numerous are lactobacilli and bifidobacteria, which attach to the vaginal epithelium. They produce alcohols, peroxide, lactic and other acids, which provide an acidic reaction in the vaginal secretion. As well as lysozyme and other enzymes that inhibit the proliferation of other types of bacteria.

Microorganisms that make up the microflora of a healthy woman

Abbreviation CFU/ml means - colony-forming units in 1 ml of nutrient medium. Each colony-forming unit is a microorganism from which a colony can form.

The number of bacteria is expressed in decimal logarithms in order to avoid writing numbers with a large number of zeros.

In the description of vaginal microflora one can often find the names gram-positive or gram-negative bacteria. These terms mean that the first bacteria are stained according to the method developed by the microbiologist Gram, while the others do not change their color.

Gram-positive rods in a smear, which include lactobacilli, are a good sign. Normally, they predominate in women of reproductive age. During menopause (menopause) and postmenopause, gram-negative bacteria come first.

Depending on their oxygen demand, bacteria are divided into

• aerobic- those that develop in the presence of oxygen;
• anaerobic- which do not require oxygen to function.

In the vagina of a healthy woman, most bacteria are anaerobes 10 8 -10 9
CFU/ml.

How to make a smear on the vaginal microflora?

A smear is taken in the gynecologist's office. A woman can also undergo this test in a private laboratory.

The procedure includes several stages.

1. The woman is placed in a gynecological chair.
2. Insertion of sterile speculum to gain access to the vaginal walls and cervix.
3. Collection of material from the posterior wall of the vagina. This procedure is absolutely painless. Unpleasant sensations can only occur when the spatula touches the inflamed area.
4. Applying material to a glass slide. The vaginal secretion is distributed with streaking movements over the skim glass in the thinnest possible layer so that the cells are arranged in one row and do not cover each other.
5. Fixation of the smear is necessary if it is delivered to the laboratory after more than 3 hours. The treatment avoids cell deformation during drying and makes it possible to preserve the drug.
6. Smear staining using the Gram method. Methylene blue is used as a dye. After staining, it is easier to establish the type of bacteria and determine the composition of the microflora.
7. Result assessment, which consists of 3 parts: leukocyte count, species composition microflora, assessment of vaginal cleanliness.

Often, a smear is taken from three points at once:

• openings of the urethra and paraurethral passages (narrow canals located parallel to the urethra);
• vaginal walls;
• cervical canal.

The anatomical proximity of these areas leads to the fact that infections and inflammations occur interconnectedly. For each area, use a separate sterile spatula, brush or cotton swab. The taken material is applied to 3 sterile glass slides, separately for each area.
A vaginal flora smear is an absolutely harmless procedure that is allowed, including for pregnant women. During the collection of material, the mucous membrane is not injured, so there are no restrictions after the procedure. It is allowed to take a bath, swim, have sexual intercourse, etc.

How to prepare for this smear?

It is necessary to take a smear for flora no earlier than 3 days after the end of menstruation. Menstrual blood cells in the smear can interfere with the results. The optimal period is considered to be from the 10th to the 20th day of the cycle.
The result of the analysis will be as reliable as possible if you adhere to the following rules.

• stop taking antibiotics and antifungal drugs 14 days before;
• 2 days in advance, stop administering any vaginal forms of drugs - solutions, suppositories, tablets, tampons, ointments, creams;
• abstain from sexual intercourse for 2-3 days;
• Before the procedure, you should not douche or wash the inside of the vagina.

What does a smear show on the vaginal microflora?

A smear on the vaginal microflora shows the presence of a number of diseases and pathological conditions.

• Sexually transmitted infections (sexually transmitted infections). They are evidenced by the presence in the smear of a significant number of ureaplasmas, mycoplasmas, gardenella, gonococci, trichomonas and other pathogenic bacteria.
• Inflammation vagina(vaginitis, colpitis) or cervical canal(cervicitis and endocervicitis). Evidence of the inflammatory process is a large number of leukocytes in the smear.
• Vaginal dysbiosis. Violation of the composition of microflora contributes to the development of diseases of the genital area. Dysbacteriosis is diagnosed when the number of lactobacilli decreases and other types of microorganisms begin to predominate.
• Candidiasis or thrush. Normally, single fungi of the genus Candida are acceptable. With a fungal infection, their number increases sharply, and pseudomycelium is found in the smear - threads of elongated cells and bud cells sitting on them.

The flora smear evaluates the following indicators:

4 degrees of vaginal cleanliness

What is the norm for a smear on the vaginal microflora?

In smear microscopy for flora, the following is considered normal:

• flat cells of the vaginal epithelium - up to 10 in the field of view;
• single leukocytes - up to 10 in the field of view;
• cells of the intermediate layer are single;
• “false key” cells - rare;
• the total number of microorganisms is “moderate”, sometimes “large”;
• mucus - in small quantities;
• Lactobacilli predominate among bacteria; other types of microorganisms are rare and rare.

The smear should not contain:

• Large numbers of destroyed epithelial cells. This indicates cell lysis, which occurs with abnormal growth of lactobacilli.
• Key cells. These are epithelial cells covered with various bacteria.
• Parabasal cells. Cells of the lower layers of the mucosa. Their appearance indicates significant inflammation or atrophy of the mucosa.
• "Massive" amount of bacteria, except lactobacilli.
• Yeast cells with pseudomycelium and blastopores (bud cells). Their presence indicates thrush.
• Strict anaerobes - most of them are pathogens.
• Gonococcus - pathogens of gonorrhea.
• Trichomonas - causative agents of trichomoniasis.
• Atypical cells which are a sign of precancerous or oncological changes .

Some microorganisms (chlamydia, various viruses) are not detected when examined under a microscope due to their small size. To identify them, a blood test for ROC is necessary.

What do leukocytes indicate in a smear on vaginal flora?

Leukocytes- These are white blood cells that are designed to fight infection. They can exit through the wall of blood vessels and move independently. Leukocytes have the ability to phagocytose - they engulf bacteria and digest them. Once the bacterium is digested, the white blood cell is destroyed. This releases substances that cause inflammation, manifested by swelling and redness of the mucous membrane.
Normally, the number of leukocytes in the vagina should not exceed 10. A large number of leukocytes indicates inflammation. The higher the number of leukocytes, the more pronounced the inflammatory process.

Why is sensitivity to antibiotics performed when examining a smear?

Antibiotic sensitivity or antibiogram- determining the sensitivity of bacteria to antibiotics. The study is carried out simultaneously with smear culture if pathogenic bacteria that cause inflammation or sexually transmitted infections are detected in the vagina.

There are a large number of antibiotics, but not all of them are equally effective against different groups of bacteria (antibiotics do not affect viruses). It happens that after a course of antibiotics the patient does not recover or the disease returns after a few days/weeks. This happened because antibiotics that had little effect on the causative agent of the disease were prescribed for treatment.
In order for treatment to be as effective as possible, it is necessary to determine which antibiotics:

• completely destroy the bacteria that causes the disease;
• stop the growth of the pathogen;
• do not affect the life activity of this bacterium.

Based on the research carried out, a antibiogram. This is a list of antibiotics to which bacteria are sensitive.

How is antibiotic sensitivity testing performed?

After the bacteria that caused the disease have been identified, they are distributed into several test tubes with nutrient media. A specific antibiotic is added to each tube. The test tubes are placed in a thermostat, where optimal conditions are created for their reproduction.

After cultivation (about 7 days), the growth of bacteria in test tubes is analyzed. Where bacteria are sensitive to the antibiotic, colonies do not form. This drug is optimal for treating the patient. In a test tube where drugs to which antibiotics are insensitive are added, the growth of bacteria is the most intense. Such drugs cannot be used to treat this disease.

What is smear culture?

Smear culture or bacteriological culture (bacteriological culture) of a smear is a laboratory test in which the contents of the vagina are placed in a nutrient medium and optimal conditions are created for the growth of bacteria.

Objectives of the study:

• identify the causative agent of genital infection;
• establish the degree of contamination - the number of bacteria in the vagina;
• monitor the state of microflora after long-term treatment with antibiotics and cytostatic drugs. It is carried out 7-10 days after discontinuation of the drug.

In what case is smear culture prescribed?

• to all pregnant women upon registration;
• with inflammatory processes in the genital organs;
• Gram-negative diplococci were found in the smear - to confirm gonococcal infection (gonorrhea);
• with vulvovaginitis, recurrent or chronic.

How is microbiological testing performed?

Vaginal discharge is placed in nutrient media - solutions or jelly-like masses that contain nutrients for bacteria. Test tubes and Petri dishes are placed in a thermostat for 3-5 days, where the temperature is constantly maintained at about 37 degrees, optimal for the proliferation of microorganisms.

After cultivation, the laboratory assistant evaluates the results. From each microorganism, during the process of division, a whole colony of bacteria grows. Based on its appearance, the laboratory technician determines the type of pathogen. And by the number of colonies one can judge the concentration of these microorganisms in the vagina. Next, the concentration is compared with normal indicators.
Those bacteria whose concentration exceeds 10 4 CFU/ml are considered significant. At this concentration, microorganisms can cause disease. If such a quantity of bacteria is detected, the result of the analysis is considered positive.

The conclusion issued by the laboratory states:

• view microorganism that predominates in the smear;
• pathogenicity microorganism - ability to cause disease:

• Pathogenic - the presence of which can only be caused by disease.
• Opportunistic - bacteria that cause disease only when immunity decreases, with a significant increase in their number.

• concentration microorganism in the vagina. In numerical terms and in the form of verbal characteristics: “meager”, “moderate growth”, “abundant growth”.

In a laboratory report, the number and growth of bacteria can be characterized by the degree of:

I degree is the norm. In degree II, they speak of a violation of the vaginal microflora. III-IV degrees indicate a disease caused by this type of bacteria.