Flora smear in women: why it is taken, indications and contraindications for the procedure. Flora smear in women. A smear from the vaginal mucosa for cleanliness - deciphering the results, how to prepare, why is it done? Normal indicators of vaginal microflora

The female reproductive system is often exposed to bacteria and infection. Often, due to certain circumstances, inflammation of organs develops. There are quite serious organs here that cannot function fully on their own. In the case of pathology of one of them - the uterus, ovaries or fallopian tubes - the woman’s entire reproductive system is damaged, the development of cancer cannot be ruled out, and infertility is often diagnosed. Therefore, representatives of the fair sex must undergo appropriate examination with the required regularity. The examination includes a mandatory examination by a gynecologist with the necessary tests to identify pathologies.

The most informative analysis includes a smear on the flora in women, which presents a complete picture of the state of the microflora of the genitals and genitals. Women will understand that the usual and well-known thrush is diagnosed with a similar analysis. But more about it later in the article.

What is a smear? A smear is a characteristic movement of a gynecologist with a cotton swab to collect the mucous membrane of the vagina, cervix or urethra. Subsequently, a corresponding study of mucosal sampling is carried out in the laboratory. According to a complete study of the results, the spread of an infectious disease or the development of a bacteriological nature is determined.

A smear is taken during a gynecological examination during a comprehensive commission or when unpleasant symptoms and complaints from the patient. Unpleasant symptoms include pain, burning in the lower abdomen or in the vagina involving the outer labia; patients often complain of pain during urination. If these symptoms are detected, you should immediately consult a doctor - even itching in the urethral area can signal the development of a gynecological disease.

Not all women know exactly the rules for collecting mucous membranes. This leads to numerous deviations from the norm, and most importantly, to a significant distortion of indicators. Therefore, women should follow the rules for collecting mucous membranes, which include:

1. 2 days before the expected examination by a gynecologist, do not have sex even with a regular partner. It is advisable not to use any suppositories or topical medications, and you should avoid all kinds of sexual activities, douching, and bathing.
2. A smear is taken in the absence of bleeding, because during menstruation the microflora completely changes its state and content.
3. Before visiting a gynecologist, you should not take a bath - washing is strictly prohibited.
4. It is forbidden to visit the toilet 2-3 hours before.

By following the rules, the woman ensures that the results of the analysis are true. The fence itself is carried out with a spatula or a special stick with a cotton tip. The sampling is carried out from three places - from the cervix, vagina and urethra. There should be no pain - if this occurs, it means that an infectious disease is developing with the presence of an inflammatory process.

Norms and deviations

In the microflora of a woman’s genital organs, 95% of lactobacilli should be present - they form lactic acid, providing the required acidity to protect against infections and other pathogens.

Depending on life circumstances (stress, decreased immunity), as well as during pregnancy, the number of lactobacilli is significantly reduced, which provokes the development of infectious lesions.

Interpretation of analyzes

As soon as a woman has received tests to determine the microflora of the genital organs, she is faced with a huge number of designations, symbols and numbers. Only a specialist can disassemble them, but with a detailed examination, you can do this yourself.

So, first, determine the indicators for the smear sampling site being studied. The letters are highlighted here:

• V– vagina;
• C– cervical canal of the cervix;
• U– urethra.

The designations identify the first letter of the place name in Latin.

1. L– leukocytes – are present in a healthy state and during the development of pathology. Their purpose is to protect the woman’s genitals from the penetration of bacteria. In normal condition, there should be no more than 10 in the vagina, no more than 30 in the cervix and no more than 5 in the urethra. When the indicators increase, an assumption is made about the presence of an inflammatory process.
2. Ep– epithelium – mucosal cells that must be present in a healthy and diseased state. The absence of epithelium indicates hormonal imbalances in women. Epithelium indicators for all mucosal sampling sites should not exceed the limit of 5-10 units. If it increases, it indicates the presence of inflammation.
3. Mucus– is necessarily present in small quantities in the vagina and cervical canal of the cervix. An increase or presence at the sampling site in the urethra indicates the presence of inflammation.
4. General indicators of microflora - definitely in the vagina Dederlein sticks must be present in large quantities. These rods are the main defenders of a woman’s microflora, which have another name – lactobacilli.

When indicators increase, the laboratory records their excess - the usual “+” signs are placed next to each indicator. Their definition appears to be:

• « + “- a small amount indicates an excess, but without the development of inflammation;
• « ++ “—a moderate increase indicates the onset of the inflammatory process;
• « +++ “—increased amount—inflammation develops and progresses;
• « ++++ “- a copious amount can signal the presence of a serious disease of the genital organs, up to advanced stages or an oncological nature.

This is a simplified form of deciphering the results. The received documents contain many more indicators.

What should not be in the results

The above indicators are not all that the results of the survey show. The forms present indicators of certain components that, in principle, should not be present in a smear for flora. The presence of numbers indicates infection; a dash means the woman is healthy.

Components that should not include the following:

1. Gonococci are gram-negative bacteria, the presence of which indicates the development of gonorrhea in a woman, as well as inflammation of the urethra, cervix, fallopian tubes or rectum.
2. Trichomonas is a bacterium of a modified form, which is rarely detected by conventional flora analysis; additional culture is recommended. Its detection in a smear indicates infection with trichomoniasis.
3. Key cells are ordinary epithelial cells that are stuck together by Gardnerella and other pathogens. Their presence in the vaginal mucosa and other examined areas indicates bacterial vaginosis.
4. Candida is a fungus that is absent or present in small quantities in healthy women. But if the presence of candida is higher than the levels of lactobacilli, there is a high probability of developing candidiasis - the usual thrush. Moreover, the disease can progress at full speed, but the woman initial stage may simply not pay attention to mild itching during urination.

In the microflora of a woman, atypical cells should also not be found - cells of a modified form, which often indicate the development cancer.

Microflora tests during pregnancy

Pregnant women undergo flora tests somewhat more often than “ordinary” women. This can be explained by a simple fear of infection or inflammation, because carrying a fetus significantly reduces the immunity of the expectant mother, which means it can lead to the development of diseases or inflammation that is not specific to the pre-pregnancy state.

The collection of the mucous membrane is carried out in exactly the same way, with the exception of the collection from the cervical canal - it is carried out more carefully so as not to provoke a miscarriage in the pregnant woman.

Why carry out such analyzes?

Surprisingly, even if a woman previously did not have any adverse symptoms, sexually transmitted infectious diseases are often detected with the onset of pregnancy. Here they highlight:

• gonorrhea;
• syphilis;
• ureaplasmosis;
• microplasmosis;
• genital herpes and other diseases.

Timely detection of present infections will allow timely treatment to begin, and, therefore, protect the child from possible infection and the development of various pathologies. During pregnancy, women produce progesterone, which can significantly affect the production of white blood cells. That is why during pregnancy up to 20 units are allowed. Its excess indicates the onset of inflammation, which often leads to miscarriage in the early stages and premature birth in the third trimester.

Unfavorable test results indicate the presence of an inflammatory or infectious disease, and this may not always be associated with the genitals. For example, in pregnant women, elevated white blood cells can help identify malaria, typhus and other similar diseases. To clarify the diagnosis, doctors prescribe additional examinations for women - DNA diagnostics, bacteriological culture and other additional studies.

A woman should be attentive to her health, including the condition of her genital organs, especially if she plans to conceive a child. Infections and bacteria often become provocateurs for the development of cancer, so at the first unpleasant symptoms you should immediately consult a doctor.

Flora smear analysis is one of the most important diagnostic methods in gynecology. A smear is taken from the mucous membrane of the vagina, cervix or urethra. This analysis allows you to assess the state of the microflora of the genitourinary system and identify the presence pathogenic microorganisms.

A smear test for flora in women is performed during a preventive examination by a gynecologist and in the presence of complaints from the genitourinary system. These include: painful sensations in the lower abdomen, itching, burning in the vagina, discharge, indicating a possible inflammatory process. It is also advisable to do this analysis at the end of a course of antibiotic therapy to prevent thrush and when planning pregnancy.

Why is this analysis prescribed?

Usually a vaginal smear is part of a woman's routine medical check-up. It is performed by a specialist during a gynecological examination. Biological material is also collected from the urethra and cervix.

This diagnostic allows you to detect possible problems with women's health, such as an inflammatory process or a disease caused by an infection. In medical terminology, such a study has another name - bacterioscopy.

A gynecological smear is taken if the following diseases are suspected:

• or vaginitis;

Specialists can prescribe a smear if the patient has the following complaints:

• Pain during sexual intercourse.
• Unpleasant-smelling copious discharge with discoloration.

A smear is taken when planning pregnancy and after antibiotic therapy. In addition, the smear allows you to monitor the effectiveness of therapy in the treatment of gynecological diseases.

Advantages of the method:

• Painless procedure.
• Simple rules for preparing for a smear test.
• Monitoring the effectiveness of treatment of female diseases.
• Possibility of identifying many diseases of the genitourinary system.

For preventive purposes, women periodically need to undergo this diagnosis. This will help prevent possible undesirable consequences.

Preparation for delivery

Some doctors say that this test does not require special preparation, however, this is not true. To ensure the reliability of the results, the patient is advised not to go to the toilet for 2-3 hours, since urine can wash away all pathogenic bacteria and infections, making it difficult for the attending physician to determine the causes of your pathological condition.

Douching, vaginal suppositories and antibacterial soap also contribute to unreliable indicators. Women must undergo this test after the end of menstruation, and in addition, all patients should refrain from any sexual intercourse 2 days before taking the biomaterial.

How is it surrendered?

The analysis is most often taken by a doctor when you come to him for a regular appointment at the clinic or when you simply go to a paid laboratory, where obstetricians and medical staff take biomaterial from you.

The gynecologist, obstetrician or any other medical professional lightly runs a special disposable stick-shaped spatula over three points - the vagina, urethra and cervical canal.

In men, a urologist or another doctor inserts a special disposable probe into the urethra, turns it around its axis several times and takes an analysis. It is believed that the examination does not cause pain, however, this does not exclude the carelessness of the doctor, as well as individual sensitivity or the presence of a particular disease, which can cause discomfort.

The meaning of the letters on the analysis form

Doctors do not use full names, but abbreviations - the first letters of each of the analysis parameters. To understand the normal microflora of the vagina, knowledge of the letter designations will be very helpful.

So, what are these letters:

1. abbreviations of the zones from which the material is taken are designated by the letters V (vagina), C (cervical area of ​​the cervix) and U (urethra or urinary canal);
2. L - leukocytes, the value of which may not be the same in normal conditions and in pathology;
3. Ep - epithelium or Pl.Ep - squamous epithelium;
4. GN - gonococcus (the “culprit” of gonorrhea);
5. Trich - Trichomonas (causative agents of trichomoniasis).

In the smear, mucus may be detected, indicating a normal internal environment (PH), beneficial Doderlein bacilli (or lactobacilli), the value of which is equal to 95% of all beneficial bacteria.

Some laboratories make it a rule to mark the content of a specific type of bacteria. For example, somewhere they use the “+” sign for this. It is put into 4 categories, where one plus is an insignificant content, and the maximum value (4 pluses) corresponds to their abundance.

If there is no flora in the smear, the abbreviation “abs” is indicated (Latin, this type of flora does not exist).

What doctors don't see with microscopy?

Using this analysis, the following conditions or diseases of the body cannot be determined:

1) Cancer of the uterus and cervix. To diagnose malignant degeneration of the endometrium, histological material is needed, and in large quantities. And they take it directly from the uterus during separate diagnostic curettage.

2) . To determine it, a smear is not needed and it does not matter what result it shows. It is necessary to take a blood test for hCG, undergo a gynecological examination by a doctor, or do an ultrasound of the uterus. It is possible to detect human chorionic gonadotropin in urine, but not in genital discharge!

3) CC and other pathologies (leukoplakia, koilocytosis, HPV lesions, atypical cells, etc.) are diagnosed based on the results of a cytological examination. This analysis is taken directly from the cervix, from the transformation zone, using a certain method with Papanicolaou staining (hence the name of the analysis - PAP test). It is also called oncocytology.

4) Does not show infections (STDs) such as:

• (chlamydia);
• (mycoplasmosis);
• (ureaplasmosis);

The first four infections are diagnosed using PCR. And to determine the presence of the immunodeficiency virus by a smear with high accuracy impossible. You need to take a blood test.

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. – must be present, but only in small quantities.
2. (L) – The presence of these cells is allowed because 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. (pl.ep.) – normally its quantity 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.
4. Dederlein's sticks healthy woman there should be a lot of them. A small number of lactobacilli indicates a disturbed vaginal microflora.

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)

A breakdown of the results of a smear analysis for flora in women is presented in the table below:

Indicator	Normal values
	Vagina (V)	Cervical canal (C)	Urethra (U)
Leukocytes	0-10	0-30	0-5
Epithelium	5-10	5-10	5-10
Mucus	Moderately	Moderately
Gonococci(Gn)	No	No	No
Trichomonas	No	No	No
Key cells	No	No	No
Candida (yeast)	No	No	No
Microflora	A large number of Gram+ rods (Dederlein rods)	No	No

Degrees of purity based on flora smear

Depending on the results of the smear, there are 4 degrees of vaginal cleanliness. The degree of purity reflects the state of the vaginal microflora.

1. First degree of purity: The number of leukocytes is normal. Most of the vaginal microflora is represented by lactobacilli (Doderlein bacilli, lactomorphotypes). The amount of epithelium is moderate. Mucus – moderate. The first degree of purity means that everything is normal for you: the microflora is fine, your immunity is good and you are not in danger of inflammation.
2. Second degree of purity: The number of leukocytes is normal. The vaginal microflora is represented by beneficial lactobacilli along with coccal flora or yeast fungi. The amount of epithelium is moderate. The amount of mucus is moderate. The second degree of vaginal cleanliness is also normal. However, the composition of the microflora is no longer ideal, which means that local immunity is reduced and there is a higher risk of inflammation in the future.
3. Third degree of purity: The number of leukocytes is higher than normal. The main part of the microflora is represented by pathogenic bacteria (cocci, yeast fungi), the number of lactobacilli is minimal. There is a lot of epithelium and mucus. The third degree of purity is already inflammation that needs to be treated.
4. Fourth degree of purity: The number of leukocytes is very large (the entire field of view, completely). A large number of pathogenic bacteria, the absence of lactobacilli. There is a lot of epithelium and mucus. The fourth degree of purity indicates severe inflammation that requires immediate treatment.

The first and second degrees of purity are normal and do not require treatment. At these degrees, gynecological manipulations are allowed (cervical biopsy, uterine curettage, hymen restoration, hysterosalpingography, various operations, etc.)

The third and fourth degrees of purity are inflammation. At these degrees, any gynecological manipulations are contraindicated. You need to first treat the inflammation and then take the smear test again.

What is coccal flora in a smear?

Cocci are bacteria that have a spherical shape. They can occur both normally and in various inflammatory diseases. Normally, single cocci are detected in the smear. If immune defense decreases, the amount of coccobacillary flora in the smear increases. Cocci can be positive (gr+) or negative (gr-). What is the difference between gr+ and gr- cocci?

To describe bacteria in detail, microbiologists, in addition to indicating their shape, size and other characteristics, stain the preparation according to special method, which is called "Gram stain". Microorganisms that remain colored after washing the smear are considered “gram-positive” or gr+, and those that become discolored when washed are “gram-negative” or gr-. Gram-positive bacteria include, for example, streptococci, staphylococci, enterococci, and lactobacilli. Gram-negative cocci include gonococci, Escherichia coli, and Proteus.

What are Doderlein sticks?

Doderlein bacilli, or, as they are also called, lactobacilli and lactobacilli, are microorganisms that protect the vagina from pathogenic infections by producing lactic acid, which helps maintain an acidic environment and destroy pathogenic flora.

A decrease in the number of lactobacilli indicates a disturbed acid-base balance of microflora in the vagina and a shift towards the alkaline side, which often occurs in women who are sexually active. The pH of the vagina is significantly influenced by both pathogenic microorganisms and opportunistic microorganisms (which are sometimes found in the vagina normally).

Flora smear during pregnancy

The microflora of each woman is strictly individual, and normally consists of 95% lactobacilli, which produce lactic acid and maintain a constant pH of the internal environment. But opportunistic flora is also normally present in the vagina. It got its name because it becomes pathogenic only under certain conditions.

This means that as long as there is an acidic environment in the vagina, opportunistic flora does not cause any inconvenience and does not actively multiply. These include yeast-like fungi, which under certain conditions can cause vaginal candidiasis, as well as gardnerella, staphylococci, streptococci, which under other conditions can cause bacterial vaginosis (inflammatory process) in a woman.

A woman’s flora can change for a variety of reasons - with decreased immunity, taking antibiotics, common infectious diseases and diabetes mellitus. One of these factors that can change the microflora is a change in hormonal levels. Thus, a pregnant woman produces virtually no estrogen until the end of pregnancy, but produces the hormone progesterone in large quantities. This hormonal background allows Doderlein's rods to increase 10 times, so the body tries to protect the fetus from possible infection during pregnancy. Therefore, it is very important to undergo an examination before a planned pregnancy to determine the degree of cleanliness of the vagina. If this is not done, then during pregnancy the opportunistic flora can be activated and cause various diseases of the vagina.

Candidiasis, bacterial vaginosis, gardnerellosis, gonorrhea, trichomoniasis - this is not a complete list of diseases that weaken and loosen the walls of the vagina. This is dangerous because ruptures may occur during childbirth, which might not have happened if the vagina was clean and healthy. Diseases such as mycoplasmosis, chlamydia and ureaplasmosis are not detected by smear analysis, and these pathogenic microorganisms can only be detected by blood analysis using the PCR (polymerase chain reaction) method, using special markers.

A smear test is taken from a pregnant woman during registration, and then for monitoring at 30 and 38 weeks. Usually, to assess the state of the vaginal microflora, doctors talk about the so-called degrees of vaginal cleanliness, which a woman should know and ensure that the required degree is maintained during pregnancy.

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To diagnose the cause of women's diseases reproductive system A gynecological smear is used to check the flora. This is a type of microbiological study that identifies opportunistic bacteria, which are often a normal component of the microbial flora of a healthy woman, and absolute pathogens that cause venereal diseases. Therefore, to correctly interpret the results, you need to contact a specialist.

Indications for the study

Signs of inflammation and the presence of infection - this is what a gynecological smear on the flora shows. Therefore, it is prescribed for the following patient complaints:

• itching in the perineum and vagina ();
• mucous or purulent vaginal discharge;
• unpleasant smell of discharge, for example, fishy.

A flora smear is also prescribed to healthy women for the purpose of early detection of infection:

• during an annual preventive examination;
• to monitor the effectiveness of antimicrobial therapy;
• before gynecological procedures and operations to prevent infection from entering other organs and blood;
• with long-term use of antibiotics to exclude vaginosis and vaginal candidiasis;
• during pregnancy.

During pregnancy, a smear for flora is taken three times: when a woman registers with a consultation, at the 30th week and at the 36th week. This is necessary to prevent infection of the child during childbirth, as well as the penetration of pathogenic microbes into other tissues.

Preparing for the study

A smear test cannot be taken during menstruation. Optimal time– the middle of the cycle, from the 10th to the 20th day after the start of menstruation.

Preparation for taking a smear for flora is as follows:

• 2 weeks before the test, stop treatment with antibiotics or antifungal agents, but if this is not possible, notify the doctor when taking a smear;
• refrain from vaginal sexual intercourse for 3 days;
• 2 days in advance, stop using vaginal suppositories, tablets, creams and other dosage forms for topical use;
• On the eve of the examination, do not douche; you can only wash the perineal area with warm water and soap.

Smear procedure

A smear on the flora in women is taken from the urethra, from the inside of the labia, the mucous membrane of the vagina and cervix. You can also obtain material for microscopy from the uterine cavity (by aspiration or curettage) and ovaries (by puncture or during surgery). Smears are also prepared from this material.

Fence gynecological smear on flora from the cervix

Smear technique:

1. Urethra: a very thin swab on an aluminum wire or a disposable bacteriological loop is used. The area of ​​the external opening of the urethra is cleaned with a gauze swab. A loop or tampon is inserted into the urethra to a depth of 1-2 cm, while lightly pressing on the side and back walls. The resulting material is placed on a glass slide by rolling a swab or moving a loop. It is used for microscopy and immunofluorescence analysis. To conduct a culture test or polymerase chain reaction (PCR), a swab or loop is placed in a test tube with a nutrient medium.
2. Vaginal vestibule and labia: a sterile swab is used. The material is taken from the inflamed area. In case of an abscess of the glands of the vestibule, it is first opened, and then the resulting contents are transferred to a glass slide.
3. Vagina: using speculum, the lower part of the vagina with the cervix is ​​exposed. A tampon is placed on a visible area of ​​inflammation or, if it is absent, in the posterior vaginal fornix. The material is evenly transferred to a glass slide, dried in air, fixed with ethanol (2-3 drops per glass), labeled, placed in a closed container and sent to the laboratory. If a culture test is necessary, for example, for trichomoniasis, the swab is placed in a test tube and immediately sent to a laboratory assistant.
4. Cervix: First, a sample is taken for culture using a cotton swab. The cervix is ​​moistened with sterile saline, the tampon is carefully inserted into the cervical canal, and then removed without touching the vaginal walls and placed in a sterile tube. To take a smear for microscopy, PCR or virological analysis, a special brush is used. It is placed in the cervical canal after collecting material for cultural examination. The insertion depth is 1-2 cm, the brush is carefully rotated, then the resulting scraping is transferred to a glass slide.

Taking swabs is a quick, painless and safe procedure.

Microscopic examination

Smear microscopy makes it possible to:

• preliminarily determine which microorganisms and in what quantities are present at the site of the disease;
• assess whether the material for analysis was taken technically correctly (for example, a smear from the cervical canal should not contain cells from the vaginal wall);
• identify some microorganisms that require special nutrient media for cultivation - gonococcus, Trichomonas, anaerobes.

Even with conventional microscopy, strict anaerobic bacteria can be detected. They are part of healthy microflora, but when accumulated in large quantities they become the cause of bacterial vaginosis. In this case, fusobacteria, bacteroides, and gardnerella are detected in smears.

Facultative anaerobes are similar in appearance, but their sensitivity to antibiotics is different. Therefore, when such microbes are identified, further cultural testing is carried out.

Thus, smear microscopy is very important for diagnosis. It is also used to detect cytolytic vaginosis and vaginal epithelial atrophy, which appears in women after menopause.

Smear microscopy is necessary to diagnose the following diseases:

• (smears from the urethra and cervical canal);

As a result of the analysis, the doctor receives data on the condition of the vaginal epithelium, the severity of inflammation and the composition of the microflora.

Microscopic examination results

To determine the total contamination with microorganisms, the following criteria are used:

• if up to 10 microbes are detected in the field of view – minimal (+);
• 11-100 cells – moderate (++);
• 100-1000 cells – large number (+++);
• more than 1000 cells – a massive amount (++++).

A qualitative analysis is also carried out, determining which microorganisms are visible in the smear. For this purpose it is painted in different ways- according to Gram or Romanovsky-Giemsa. In conclusion, the doctor reflects the detected microorganisms and their quantity.

Normal indicators when examining vaginal microflora:

• lactobacilli - up to 10 7 - 10 9 CFU/ml;
• bifidobacteria – up to 10 7;
• corynebacteria, streptococci – up to 10 5;
• clostridia, propionibacteria, mobiluncus, peptostreptococci, staphylococci, Escherichia coli, bacteroides, prevotella, candida - up to 10 4;
• porphyromonas, fusobacteria, veillonella, ureaplasma, mycoplasma - up to 10 3.

CFU is a colony-forming unit, that is, one microbial cell. When cultivated on a nutrient medium, it will multiply and form a separate colony.

The sensitivity of light microscopy is in the range of 10 4 -10 5 CFU/ml. Therefore, those bacteria that are contained in smaller quantities in the discharge may not be detected, and this is normal.

Sometimes the transcript of the results does not contain a detailed listing of the types of bacteria detected. In this case, in the analysis form you can see the terms:

• sticks (this is the normal microflora of the vagina);
• cocci (round-shaped bacteria, often the cause of inflammation - streptococcus, staphylococcus);
• mixed flora (usually found with bacterial vaginosis).

Also, as a result of the study, there may be indications of the presence of a large number of flat epithelium and leukocytes (indicators of inflammation), as well as mucus and “key” cells - epithelial cells, surrounded on all sides by bacteria.

Determination of purity degree

Based on the results of microscopy, the doctor makes a conclusion about the so-called degree of vaginal cleanliness. There are 4 such degrees:

1. Very rare in sexually active women

An acidic environment is detected, up to 10 leukocytes and epithelial cells, a small amount of mucus. The microflora is represented by lactobacilli, other microorganisms can be only isolated.

1. The norm corresponds to the complete health of the genital organs

Unlike the first degree, the environment of the discharge is slightly acidic; gram-positive cocci are present in small quantities.

1. Signs of colpitis - inflammation of the vaginal walls

The environment is neutral, there are more than 10 leukocytes and epithelium in the field of view, a moderate amount of mucus, “key” cells. Pathogenic microorganisms are present (gram-positive and gram-negative bacilli, cocci), and the number of lactobacilli is less than normal.

1. Severe inflammation

The environment is neutral or alkaline, there are more than 30 leukocytes, epithelium and mucus in large quantities. Pathogenic microorganisms are in large quantities, corresponding to different degrees of microbial contamination. Lactobacilli may be absent.

The norm of leukocytes during pregnancy, as well as other indicators of microbiological testing, are the same as in a non-pregnant woman. An increase in the number of leukocytes, epithelium, or the appearance of pathogenic microorganisms indicates the development of an inflammatory process and requires treatment.

Cultural examination

If pathogenic bacteria are detected in a flora smear, it is necessary to establish their type and sensitivity to antibiotics. For this purpose, cultural research is used. This is the main method for recognizing gonorrhea, trichomoniasis,.

Determining antibiotic sensitivity is especially important for infections caused by opportunistic microbes. It should be borne in mind that sometimes they are found in the vagina in rather small quantities, and are not distinguished by ordinary microscopy. Therefore, only a culture test can detect such microbes.

For analysis, the material obtained by taking a smear is placed on a special nutrient medium and cultivated, that is, kept in favorable conditions for some time. At the same time, bacteria begin to multiply, their number increases, and it becomes possible to identify them. After determining the leading pathogen, an analysis of its sensitivity to antibacterial drugs. Therefore, the analysis takes quite a long time - up to a week.

Using a culture test, you can detect pathogenic fungi, Escherichia coli, staphylococci, streptococci, corynebacteria, Neisseria, enterococci and other microbes and prescribe the correct treatment for the infection.

Pap smear results for certain pathological conditions

It is better to entrust the interpretation of the result to a specialist. However, a woman has the right to independently determine how healthy the state of her reproductive system is. Below are examples of the most common findings for various gynecological diseases.

Bacterial vaginosis:

• there are surface epithelial cells, often there are “key” cells;
• leukocytes are normal;
• the total number of microbes is large or massive (10 9 CFU/ml or 9 lg CFU/ml);
• gardnerella and anaerobes predominate, lactobacilli are absent (less than 10 5 CFU/ml);
• When cultivated in the presence of air, there is no growth of microorganisms, or there is a small amount of opportunistic flora, since anaerobes die in air.

Candidal vaginitis:

• the epithelium is not only superficial, but also from intermediate and even deep layers, depending on the severity of the lesion;
• leukocytes from 10 to 50 or more in the field of view;
• the total number of microbes is not more than 10 8 CFU/ml, of which lactobacilli are more than 10 6 CFU/ml;
• yeast fungi are detected in quantities of more than 10 4 CFU/ml;
• if fungi are found in quantities of less than 10 4 CFU/ml, this is an asymptomatic carriage of candidiasis.

When candidiasis and vaginosis are combined, changes of both types are observed simultaneously, but lactobacilli are replaced by gardnerella and anaerobes.

Nonspecific vaginitis:

• there is a large number of superficial and intermediate, less often parabasal epithelium;
• leukocytes more than 10 per field of view;
• the total number of microbes is moderate;
• Escherichia coli or gram-positive cocci predominate;
• lactobacilli are absent or isolated.

Vaginal epithelial atrophy (normal in older women):

• the epithelium is intermediate and parabasal, that is, the surface cells disappear;
• leukocytes up to 10 per field of view;
• microorganisms, including lactobacilli, are not detected, or their number is extremely low (up to 10 4 CFU/ml).

For specific infections caused by sexually transmitted infections, trichomonas, chlamydia, gonococci and other similar pathogens are found in the smear. The rest of the picture will correspond to nonspecific vaginitis.

Women's examinations

The process of taking a smear

Gynecological examination of a smear is carried out today with modern devices (microscopes, etc.). Smear microscopy allows you to study in detail the microflora of the genital tract, determine the form of the disease, its severity, and also helps prescribe the necessary medications to promote recovery.

Female examinations should be carried out in sterile rooms, using disposable gynecological kits, in compliance with a regulated sequence of actions. Note that smears in gynecology are taken from the vagina, cervical or urethra, as well as from the rectum.

It is important not to damage the walls and tissues during the procedure. Otherwise, it may cause discomfort in the future or other diseases.

Let's take a step-by-step look at how smears are examined.

1. Insertion of a gynecological speculum. This stage is typical only for women who are sexually active.
2. Taking a smear using a spatula or spatula.
3. Applying material to a glass slide.
4. Sent to the laboratory for study.

After the material arrives at the laboratory, the specialist colors it, waits for it to dry completely, and only then begins to examine the gynecological smear. Using a microscope and staining, a laboratory technician can see various bacteria, fungi, infections, and determine their number and ratio. After research work The specialist writes down the results on a special form and passes them on to the attending physician.

Women's smears under a microscope, or rather, their results, will not take long to arrive - they arrive within one working day.

In turn, the leading gynecologist, based on the results of the analysis, writes down his final verdict and prescribes treatment. If there is any doubt about the correctness of the result, a repeat vaginal smear is prescribed.

Decoding the results

When you hold your results in your hands, the question involuntarily arises of what the smear at the gynecologist shows (the Latin letter and numbers next to it) and how to understand the encrypted results. Let's figure it out.

• Latin "V" - vagina. The adjacent numbers show the contents of the smear.
• The Latin "C" stands for "cervix". The numbers will tell the doctor about all the changes that can be observed in the area under study.
• The Latin "U" means "urethra". The meaning of the numbers is the same as for a cervical smear.
• Latin "L" - leukocytes.
• "Ep" - squamous epithelium.
• The line with “abs” indicates bacteria and infections that you have not detected.
• “gn” and “trich” - gonococci (the causative agent of gonorrhea) and the bacterium trichomoniasis, the causative agent of trichomoniasis.

For visualization, you can view an atlas of gynecological smears, which will allow both gynecologists and the patient to understand or better understand the diagnosis and possible pathologies. All atlases are illustrated and have detailed comments.

Norms of smears for flora

Flora smear analysis has its own standards, which can be found below. The norm is affected by age. So, for example, for girls under fourteen years old there are one indicators, for women after menopause - different. Therefore, the presented norms are typical for women aged 14 to 45-50 years.

• Leukocytes. (V) 0 - 10 in the field of view, (C) 0 - 30 in the field of view, (U) 0 - 5 in the field of view. In case increased level leukocytes we can talk about inflammatory processes in a certain area.
• Epithelium. In all positions (V, C, U) it should be “moderate”. If the indicator increases, one should talk about inflammation, and a decreased level indicates a lack of estrogen (female sex hormone).
• Mucus. In the case of (V) and (C) - “moderately”, and in the case of (U) - “moderately” or “absent”. A large amount of mucus indicates inflammation.
• Gram-positive rods (gr.+). (V) - “large amount”, (C) - “absent”, (U) - “absent”. These results indicate good immunity and about the normal state of microflora.
• Gram-negative rods (gr.-). (V), (C), (U) - “absent everywhere.” The presence of rods indicates dysbacteriosis and inflammation.

Reminder for those planning to take a smear test

How to prepare for a flora smear and what you should not do before taking it should be remembered right now, because compliance with the rules and hygiene standards is the key to the correct and reliable result of the study and the subsequent prescription of treatment.

• A vaginal smear for flora involves stopping taking any vaginal medications for three days and abandoning all antibacterial agents.
• A smear for microflora in women or any other type of smear is not given during menstruation or 1-2 days after its end.
• Before the analysis (the night before and in the morning), it is forbidden to wash or douche.
• It is necessary to abstain from sexual intercourse.

A smear in gynecology is more than just a necessity, because such tests are vital. Timely detection of diseases is the key to rapid and effective treatment. Therefore, do not neglect the rules, preventive methods and visit your gynecologist regularly.

Flora smear in women- a laboratory test that determines the types of bacteria that are present in the vagina. This is the most common and simplest method for detecting inflammation and STDs (sexually transmitted diseases).

The examination is absolutely painless. It is performed during a routine gynecological examination. The doctor takes the material with a disposable spatula from the walls of the vagina and cervix. The contents of the vagina (vaginal secretions) are applied to the glass. In the laboratory, the material is stained so that the bacteria become clearly visible.

Purpose of the study

• determine the state of the vaginal microflora;
• identify sexually transmitted infections and their causative agent;
• determine the degree of the inflammatory process;
• assess the degree of cleanliness of the vagina, which is mandatory before further diagnostic studies and gynecological operations - cauterization of erosions, removal of polyps, curettage;
• assess the health status of pregnant women.

When does a gynecologist take a smear for flora?

• complaints of itching or vaginal discharge, other symptoms of inflammation;
• preventive examinations;
• control of the treatment;
• taking hormonal drugs and immunosuppressants;
• control of microflora during long-term use of antibiotics;
• pregnancy. It is carried out 3 times during pregnancy (at registration, at the 30th and 36th week).

This study has many names: flora smear, general smear, bacterioscopy, smear for cleanliness. There are also smears for flora from the urethra and cervical canal. Usually these three types of smears are performed together.

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

Microorganisms	Number of CFU/ml
Lactobacilli or Doderlein sticks Lactobacillus spp.	10 7 -10 9
Bifidobacterium Bifidobacterium spp.	10 3 -10 7
Clostridia Clostridium spp.	Up to 10 4
Propionibacterium spp.	Up to 10 4
Mobiluncus Mobiluncus spp.	Up to 10 4
Peptostreptococcus Peptostreptococcus spp	10 3 -10 4
Corynebacterium spp.	10 4 -10 5
Staphylococcus Staphylococcus spp.	10 3 -10 4
Streptococci Streptococcus spp.	10 4 -10 5
Enterobacteriaceae	10 3 -10 4
Bacteroides spp.	10 3 -10 4
Prevotella spp.	Up to 10 4
Porphyromonas Porphyromonas spp.	Up to 10 3
Fusobacterium Fusobacterium spp.	Up to 10 3
Veilonella spp.	Up to 10 3
Mycoplasma M.hominis	Up to 10 3
Ureaplasma U.urealyticum	10 3
Candida - yeast-like fungi	10 4

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 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 in a streak-like motion over the fat-free 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. Evaluation of the result, which consists of 3 parts: counting leukocytes, species composition of 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 the smear reveals pseudomycelium - threads of elongated cells and bud cells sitting on them.

The flora smear evaluates the following indicators:

4 degrees of vaginal cleanliness

Degree	Identified changes	What is he talking about?
I	The environment is acidic. Leukocytes - up to 10. Epithelial cells - 5-10. Most microorganisms are lactobacilli (Dederlein bacilli). Other bacteria - sporadically. Mucus - a small amount.	Ideal state of vaginal microflora. It is extremely rare in women of childbearing age who are sexually active.
II	The environment is slightly acidic. Leukocytes - up to 10. Epithelial cells 5-10. Most are Dederlein sticks. Gram-positive cocci in small numbers. Small amounts of mucus.	Normal condition. Occurs in most healthy women.
III	The environment is neutral. Leukocytes - over 10. Epithelial cells - over 10. Microorganisms in moderate or large quantities. Gram-negative and gram-negative rods and cocci are present. Single Dederlein sticks. "Key" cells are present. Mucus - moderate amount.	Inflammation of the vagina - colpitis. Symptoms may occur: creamy vaginal discharge, itching, burning, discomfort during sexual intercourse. Some women are asymptomatic with this condition.
IV	The medium is neutral or alkaline, pH over 4.5. Leukocytes - over 30 or the entire field of view. Epithelial cells - in large numbers. Microorganisms in massive quantities. The microflora is represented by various opportunistic and pathogenic microorganisms. Dederlein's rods may be absent. There is a lot of mucus.	Severe inflammatory process. Symptoms: copious vaginal discharge (white, yellowish, greenish), often with unpleasant smell. Itching, burning, dryness, discomfort. Unpleasant sensations, pain during sexual intercourse.

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 medicines 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. According to her 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 values.
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:

Degree	Features of bacterial growth
	Liquid culture medium	Dense nutrient medium
I	Growth is very poor.	There is no bacterial growth.
II	Moderate growth	Up to 10 bacterial colonies.
III	Abundant growth.	From 10 to 100 colonies.
IV	Massive growth.	Over 100 colonies.

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.