A smear - why is it needed?

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The site provides background information for information only. Diagnosis and treatment of diseases must be carried out under the supervision of a specialist. All drugs have contraindications. A specialist consultation is required!

Flora swab

Preparation for the test:

• You should not urinate for 2 hours before the test,
• For 24 hours you should not copulate, use vaginal preparations.

Smear analysis

Bacterial culture
The biological material obtained from the patient is sown on special nutrient media and left for 7-15 days at a temperature favorable for the growth of microbes. The duration of cultivation depends on the suspected microorganism. The longest result is obtained when infected with chlamydia - in 15 days. This study allows you to immediately determine an effective antibiotic.

The smear rate for flora. Purity

In the third degree there are more coccal microorganisms than lactobacilli, and there are also a lot of leukocytes.

But at the fourth degree There are no lactobacilli at all, the microflora is represented by pathogenic agents, there are symptoms of inflammation, acidity is favorable for the development of microbes.

Norms:
1. Squamous epithelium in the smear should be, if it is not there, this indicates atrophy of the genital mucosa. This indicator is influenced by the phase of the menstrual cycle.
2. Leukocytes - up to 10 units in the field of view in the vagina and up to 30 in the cervical canal
3. Staphylococcus aureus - may be present in small amounts
4. Sticks - healthy microflora
5. Coccal microorganisms - a sign of infection

6. Small sticks ( gardnerella) - indicate the presence of dysbiosis or gardnerellosis
7. Key or "atypical" cells - indicate dysbiosis
8. Fungus - indicates the presence of candidiasis, in the presence of disputes about the asymptomatic course of the disease
9. The presence of Trichomonas indicates infection.

Most often, when pathogens are detected in a smear, additional studies are prescribed, for example, bacterial culture, PCR.

Pregnancy smear

You should not refuse tests, since it is very important to clear the birth canal from infection before giving birth. Otherwise, there is a chance that the baby will be infected during childbirth. Sometimes infection of the fetus is possible even before birth. The presence of pathogenic microbes in the birth canal can complicate the course of labor and postpartum recovery.

Smear rates in men

7. Candida - no
8. Microflora - coccal microorganisms in single quantities

Throat and nose swab

After smear

Oncocytology smear

• It is advisable to abstain from sexual intercourse for 24 hours,
• You should not be tested during courses of drug therapy.

Decoding the results:
Results are assigned one of five classes:
1. Healthy cells
2. Inflammation present
3. There is a possibility of malignancy
4. There are a small number of malignant cells
5. There are many malignant cells, a tumor is present.

Pap smear

Pap smear interpretation:
1. Negative - all cells of biological material are healthy and not modified.
2. Positive - the material contains modified cells ( deformed or enlarged). A positive result does not mean that the woman is already sick.

Flora smear in women- laboratory research 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 study is absolutely painless. It is done during a routine pelvic exam. The doctor takes the material from the walls of the vagina and cervix with a disposable spatula. The contents of the vagina (vaginal secretions) are applied to the glass. In the laboratory, the material is dyed to make the bacteria clearly visible.

Purpose of the study

• determine the state of the vaginal microflora;
• identify genital 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 swab for flora?

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

Normal vaginal microflora

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

Microorganisms that make up the microflora of a healthy woman

The number of bacteria is expressed in decimal logarithms, in order not to write numbers with many zeros.

In the description of the vaginal microflora, you 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 sticks 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 out on top.

Depending on the oxygen demand, bacteria are divided into

• aerobic- those that develop in the presence of oxygen;
• anaerobic- which do not need oxygen for their vital functions.

CFU / ml.

How is a smear done on the vaginal microflora?

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 back of the vagina. This procedure is completely painless. Unpleasant sensations can occur only when the spatula touches the inflamed area.
4. Applying material to a glass slide. The vaginal secretion is spread by stroking movements over the defatted glass in the thinnest possible layer so that the cells are located in one row and do not close each other.
5. Fixation of the smear is necessary if it is delivered to the laboratory after more than 3 hours. Processing allows to avoid deformation of cells during drying and makes it possible to preserve the drug.
6. Staining the smear by 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 the cleanliness of the vagina.

• the openings of the urethra and paraurethral passages (narrow channels parallel to the urethra);
• the walls of the vagina;
• cervical canal.

How do you prepare for this smear?

• stop taking antibiotics and antifungal drugs in 14 days;
• in 2 days, stop the introduction of any vaginal forms of drugs - solutions, suppositories, tablets, tampons, ointments, creams;
• refrain from intercourse for 2-3 days;
• before the procedure, do not douche and wash inside the vagina.

What does a smear show on the vaginal microflora?

• 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 an inflammatory process is a large number of leukocytes in a smear.
• Dysbacteriosis of the vagina... 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 permissible. With a fungal infection, their number increases sharply, pseudomycelium is found in the smear - threads of elongated cells and kidney cells sitting on them.

4 degrees of vaginal cleanliness

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

• 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 - rarely;
• the total number of microorganisms is "moderate", sometimes "large";
• mucus - in small quantities;
• lactobacilli predominate among bacteria, other types of microorganisms are single, are rare.

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

What do leukocytes in a smear on vaginal flora say?

Why is antibiotic susceptible to smear testing?

Antibiotic sensitivity

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

• completely destroy the bacteria - the causative agent of the disease;
• stop the growth of the pathogen;
• do not affect the vital activity of this bacterium.

How is antibiotic susceptibility testing done?

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

What is smear culture?

Research Objectives:

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

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

How is microbiological testing done?

The vaginal discharge is placed in culture media - solutions or jelly-like masses, which contain nutrients for bacteria. Test tubes and Petri dishes are placed in a thermostat for 3-5 days, where a temperature of about 37 degrees is constantly maintained, which is optimal for the reproduction of microorganisms.

After cultivation, the laboratory assistant evaluates the results. From each microorganism, in the process of division, a whole colony of bacteria grows. By its appearance, the laboratory assistant determines the type of pathogen. And by the number of colonies, one can judge the concentration of these microorganisms in the vagina. Further, the concentration is compared with normal values.
Those bacteria, the concentration of which exceeds 10 4 CFU / ml, are considered significant. At a given 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 indicates:

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

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

• concentration microorganism in the vagina. In a numerical indicator and in the form of a verbal characteristic: "poor", "moderate growth", "abundant growth."

Leukocytes in a smear in the overwhelming majority of cases are a sign of an inflammatory process in the organs of the urogenital tract, both female and male. However, a rare man, especially at a young age, can "boast" that a smear was taken from him, if everything is in order with the genitourinary system. For men, smears are not mandatory tests during clinical examination. Women are another matter. Probably, those do not exist, which, at least once a year, are not subjected to such manipulations. And this is in the absence of pathology, but if there are problems, then smears are taken as needed.

Norm and pathology

Material from the urethra of a man at normal does not differ in abundance. Single leukocytes, transitional epithelium in a smear, single sticks - that's all that a healthy man can provide us with. The appearance of a large number of leukocytes in a smear of the stronger sex, as a rule, is accompanied by the presence of the culprits of inflammation(, yeast-like fungi of the genus, etc.), which is treated, and then they take an analysis again to make sure that the measures taken are successful.

As for women, an increased number of leukocytes is observed before menstruation and is considered an absolutely natural phenomenon. In addition, the increased content itself (the norm is up to 30 cells in the field of view) does not apply to reliable indicators, the absence of morphological signs of these cells is considered to be evidence of the norm of leukocytes. They are “calm”, not destroyed (the nuclei are preserved), there are no signs of phagocytosis. In addition, sometimes incorrectly taken material can become the cause of the diagnostician's delusion. An example is a "thick" smear, which is practically invisible due to the fact that the entire field is dotted with clusters of overlapping cells (including leukocytes). Without risking a mistake, in such cases, the woman is offered to take the test again.

Table: smear test rates for women

V - material from the vagina, C - cervical canal (cervix), U - urethra

Flora and cytology - what is the difference between them?

If in men the analysis is taken only from the urethra, then in women there are more objects of study: urethra, vagina, cervix, cervical canal. True, sometimes they take an aspirate from the uterine cavity and also make smears, but this is considered a biopsy material that is examined by a cytologist. He also makes a conclusion. Aspirates are not taken during routine examinations, this analysis is used exclusively for diagnostic purposes to detect cancerous and precancerous diseases of the main genital organ in women. In addition, if the aspirate is poured with formalin, and then applied to glass and painted, then a histological specimen will be obtained, which is considered the last resort in the diagnosis of malignant neoplasms.

Probably, many have heard the expressions: “smear for flora”, “smear for cytology”. What does all this mean? How are they similar and how are they different?

The fact is that in a smear on flora at high magnification with immersion, a doctor can count cells, detect Trichomonas, yeast, diplococci, gardnerella and other microorganisms representing a rich biocenosis of the female genital area. But he will not be able to determine morphological changes in the epithelium, since these are different areas of laboratory diagnostics, where cytology occupies a separate niche. The study of the cellular composition of some material requires, in addition to certain knowledge, also special training. The study of pathological changes in the cell and nucleus theoretically gives very little; here, as they say, a trained eye is needed.

Deciphering the analysis in both cases (flora and cytology) is dealt with by the doctor, we only have to get a little familiar with some concepts, so that, faced with a similar problem, we do not get scared and do not panic.

Cytological examination

The tasks and functions of cytology are much broader, therefore, its capabilities are also wider. The doctor examining the material focuses on the condition of the epithelial cells in order to identify pathological processes (inflammation, dysplasia, malignant neoplasms) and at the same time notes the flora. Most often, the vaginal portion of the cervix, represented by multilayer (four-layer) squamous epithelium (MPE) and the cervical canal, is subject to examination. With a correctly taken smear from the cervical canal in the cytological specimen, at the norm, the prismatic (cylindrical) epithelium, single leukocytes and depleted microflora, which could have come from the underlying sections (from the vagina, for example), are clearly visible.

It should be noted that the cytological preparation is more informative, since the staining method (according to Romanovsky-Giemsa, Pappenheim or Papanicolaou) gives a clearer picture. The cells are viewed first at low magnification in order to assess the general condition of the drug, and then at high magnification (with immersion) in order to consider not only the epithelium itself, but also the changes in the nucleus characteristic of a particular disease. In a word, the cytologist sees the flora, inflammation, and in most cases its cause and the changes that this inflammatory process entailed. As well as indicative signs of infections presenting particular difficulties in diagnosis, precancerous and neoplastic conditions of the epithelium.

Video: about smear for oncocytology

Indirect signs of some STIs in cytology

As for the smear for STIs, it is advisable to investigate it as a cytological preparation. A smear taken on the flora and stained with methylene blue is the most important, affordable and cheap, and therefore the most common diagnostic method in gynecology. However, unfortunately, it does not provide the necessary completeness of the picture for the diagnostic search for STDs and their consequences.

In addition to all possible inhabitants, which are visible in a smear on flora (Trichomonas, yeast, leptotrix) in the case of infection or violation of the biocenosis, indirect signs of the presence of microorganisms can be found in the test material (cytology), which are very problematic to identify using microscopic methods:

• The appearance of giant multinucleated MPE cells, sometimes of a rather bizarre shape, often showing signs of parakeratosis and hyperkeratosis (keratinization), indicates a possible lesion;
• Cells in the form of an "owl's eye" with a coarse-grained cytoplasm are characteristic of;
• When you can detect koilocytic atypia (MPE cells with large nuclei and a zone of enlightenment around the nucleus);
• Provacek's little bodies in the cells of metaplastic epithelium, which are typical for and play a role in screening studies, are also indicative.

Of course, it is impossible to diagnose herpes, cytomegalovirus or human papillomavirus infection during cytological analysis, but it can be assumed, and this is already the basis for further, more in-depth examination in a specific direction (, etc.). Thus, cytology allows you to narrow the range of diagnostic searches, avoid unnecessary tests, save time, and promptly start treatment.

How to properly prepare for the analysis?

Since the simplest and most accessible method for detecting inflammatory processes of the urogenital tract, both in men and women, is a smear on the flora, it needs to pay more attention and teach the reader to understand a little about the entries entered in the form.

However, before making a visit to the doctor, patients should know some simple rules:

1. A couple of days before the test, it is necessary to exclude not only sexual intercourse (sometimes sperm can be seen in a woman's smear), but also all sorts of interventions such as douching, the use of topical medications (suppositories, creams, tablets);
2. You should not go to such a study during menstruation, because menstrual blood will interfere with viewing the drug, where the doctor will see mainly it;
3. On the day of the examination, you need to calculate the time so that you urinate for the last time in 2-3 hours, since urine can wash out all the "information";
4. 7-10 days before the analysis, stop taking pharmaceutical drugs, especially antibacterial drugs, or take a smear only a week after the end of treatment;
5. Another rule that women often ignore is not to use intimate hygiene products. Of course, it is very difficult to refrain from such procedures at all, as experts recommend, but at least you can limit yourself to clean warm water. Men, on the other hand, carry out the last toilet of the external genital organs in the evening on the eve of visiting a doctor.

After following these tips, a person goes to an appointment, where they will take a smear, paint and look under a microscope. The doctor will deal with the decoding, and the patient will receive a conclusion in his hands, and he will probably be interested to know what all these numbers and words mean.

Video: preparing for a smear

What can be seen in a urethral smear in men?

Probably, the reader guessed that the sampling of analysis from men is unlikely to leave pleasant memories, because the object of study is not so accessible for them, therefore, there will indeed be unpleasant sensations that may not leave the person for several more hours. Sometimes, in order to avoid this, the doctor prescribes a prostate massage to the patient, which is carried out a few days before the per rectum procedure, that is, through the rectum.

However, if the burning sensation and soreness in the penis continues to remind of itself for several days, and similar phenomena have been added to these phenomena, a trip to the doctor is inevitable. But if everything went well, then maybe the men will be reassured by the fact that in their smear taken from the urethra, everything looks much easier, if, of course, analysis is normal:

• The norm of leukocytes is up to 5 cells in the field of view;
• Flora is composed of single rods;
• The general background dilutes the urethral epithelium (mainly transitional) - approximately 5-7 (up to 10) cells;
• A small amount of mucus that does not matter;
• Sometimes conditionally pathogenic flora may be present in a smear in single specimens (streptococci, staphylococci, enterococci), but in order to differentiate it, it is necessary to stain the smear according to Gram.

In the case of an inflammatory process, the smear changes:

1. A large number of white blood cells appears in the smear, sometimes not countable;
2. Coccal or cocco-bacillary flora displaces bacillus;
3. The preparation contains microbes that caused inflammation (Trichomonas, gonococcus, yeast, etc.);
4. Microorganisms such as chlamydia, urea- and mycoplasma under a microscope are hardly possible to see, just as it is possible to distinguish pathogenic diplococci that cause gonorrhea from paired enterococci or a chain of Enterococcus faecalis (enterococci too) from streptococci, therefore, in such cases, to clarify the species the pathogen, the study is supplemented with a cultural method or the almost universal and popular PCR (polymerase chain reaction) in our time;
5. With rare exceptions, E. coli can be found in a male smear (a flagrant violation of hygiene rules!), Which is beneficial in the intestines, but causes cystitis, getting into the man's urethra. For its differentiation, additional laboratory research methods are also required.

They do the same with female smears, since the found diplococci may by no means turn out to be Neisseria and not cause gonorrhea. By the way, E. coli (Escherichia coli), enterococcus (Enterococcus faecalis), staphylococci with streptococci and other microorganisms in female smears are much more common, due to the structure of the female genital organs.

Ecosystem of the female urogenital tract

Leukocytes in a smear taken in gynecology, even for flora, even for cytology, are not the only cells present in the preparation. In addition, they act only as a consequence or reaction to events occurring in the ecosystem (fluctuations in hormonal levels, inflammation). For example, their increase in different phases of the cycle is due to hormonal influence, therefore, when taking material, the date of the last menstruation is indicated in the referral form.

The diagnostic criterion of the inflammatory process is considered not only a large amount of Le, "escaped" to the place of "military operations", but also the state of their nuclei. When the leukocytes react, they try to absorb the "enemy", phagocytose, but they themselves begin to break down. The destroyed cells are called neutrophilic leukocytes, however, this phenomenon is not indicated in the decoding of the analysis. A large number of neutrophilic leukocytes, together with an abundant cocco-bacillary or coccal flora, serves as the basis for confirming the presence of an inflammatory process.

The ecosystem of the female genital organs includes microorganisms that occupy certain niches, which are: the epithelium of the vagina, cervix, cervical canal, rich in endocervical glands. These anatomical formations provide conditions for the vital activity of certain microorganisms. Some of the inhabitants are obligatory (obligate), while others come from the outside due to certain circumstances and cause various inflammatory reactions of the epithelium.

In addition, the balance in the ecosystem can be disturbed by various factors that negatively affect the woman's body (both internal and external), which lead to the fact that microbes living in small numbers begin to displace natural inhabitants representing the rod flora, and occupy the dominant position. An example of this is the colonization of the vaginal environment with gardnerella, which, for a number of reasons, displaces lactobacilli (Doderlein's sticks). The result of such a "war" is widely known.

The norm in the gynecological smear

Microscopic creatures living in the genital tract of a woman are diverse, but the norms still exist, although sometimes their boundaries are very difficult to determine, but we will still try to do it. Thus, in a smear taken in gynecology, you can find:

• Leukocytes, the norm of which in the urethra is up to 10 cells in the field of view, in the cervix and its canal - up to 30 cells. During pregnancy, these indicators change upward;
• The type of epithelium in the smear depends on the place of sampling: the urethra neck, the vagina are lined with stratified squamous epithelium (MPE), which we get in the preparation. A swab from the cervical canal will be represented by a cylindrical (prismatic) epithelium. The number of cells changes in different phases of the cycle, but in general, it is generally accepted that at a normal rate, their content should not exceed 10 units. However, all this is very arbitrary, since for accurate diagnosis it is necessary to take into account morphological changes in cell structures(nucleus, cytoplasm, the presence of "naked nuclei"), that is, to carry out a cytological analysis;
• Mucus in the preparation is considered a mandatory, but moderate, component, because the glands of the cervical canal and vagina secrete it. Mucus looks interesting in the ovulatory phase of the menstrual cycle, it crystallizes and forms patterns similar to plant leaves, which are called the "fern symptom" (cytology);
• A normal smear is usually represented by bacillus flora (lactobacilli) and single cocci.

Conditionally pathogenic flora is not always the norm

In addition to lactobacilli - the main representatives of the normal microflora of the genital tract, which are entrusted with the important function of "self-cleaning the vaginal environment", in the smear you can find in small quantities other opportunistic microorganisms:

All these representatives of microflora can live without disturbing anyone, or cause inflammation under certain conditions. By the way, even lactobacilli in excess and in abundant bacterial flora can provoke an inflammatory process - lactobacillosis, manifested by itching, burning, discharge. The disease, of course, is not fatal, but very painful.

Pathogenic "guests"

The presence of pathogenic microorganisms, transmitted mainly through sexual contact, almost always leads to trouble. Local inflammation caused by the pathogen can spread to other organs and systems and (often) become chronic if not cured in time.

This phenomenon is especially dangerous during pregnancy, since many pathogens are capable of providing very negative impact on the fetus, therefore, a bad smear during pregnancy is a guide to action, moreover, immediate. What microorganisms can threaten the human reproductive system through sexual transmission? Probably, we will not surprise anyone by naming them, but once again it still does not hurt to recall the danger posed by microscopic creatures.

gonococcus - the causative agent of gonorrhea

Thus, the pathogenic microflora of the genital tract includes:

What is the degree of purity?

A smear on the degree of cleanliness of the vagina is taken as a regular smear on the flora, but assessed somewhat differently. In gynecology, grade IV is distinguished:

I degree- the phenomenon is quite rare, the smear is clean, only bacillus flora, single leukocytes and squamous epithelial cells in optimal quantities;

II degree- among the rods, single cocci can "slip" or other non-pathogenic microorganisms can also be mixed in single copies, this degree is the most common among gynecologically healthy women;

table: standards for assessing vaginal cleanliness

III degree- it is characterized by conditionally pathogenic flora and yeast-like fungi, which tend to actively reproduce. This may indicate the development of an inflammatory reaction to the presence of an excessive amount of opportunistic microorganisms. This analysis involves an additional examination of the woman;

IV degree- signs of an obvious inflammatory process: abundant coccal or cocco-bacillary (mixed) flora, possibly the presence of Trichomonas, gonococci or other pathogenic microorganisms. In such cases, additional laboratory tests (bacteriological, PCR, etc.) are prescribed to search for the pathogen and further treatment.

A smear on flora, although it is considered a simple method, has great potential. The first step in the laboratory diagnosis of diseases of the urogenital tract, sometimes, immediately solves the problem and allows you to immediately start medical measures, the quality of which will subsequently be controlled by the smear itself, therefore it is not recommended to avoid such an accessible procedure. It does not require a lot of costs, and you will not have to wait long for an answer.

A general (urogenital) smear is carried out by the method of bacterioscopy (examination under a microscope). Is the most simple method definition of sexually transmitted diseases.

Indications for taking a smear

• the presence of vaginal discharge, indicating a possible inflammatory process;
• lower abdominal pain;
• burning or itching in the vagina;
• long-term use of antibiotics;
• planning pregnancy;
• preventive examination.

The degree of cleanliness of the vagina

According to the study of the general smear, four degrees of vaginal cleanliness are distinguished:

• 1st degree: typical for healthy women. The vaginal microflora is optimal. This degree is extremely rare.
• 2nd degree: there are slight deviations of the microflora. Most common cleanliness among healthy women.
• 3rd degree: abnormalities are found in the smear (an increase in the number of fungi, the growth of opportunistic bacteria). This degree indicates the presence of an inflammatory process.
• 4th degree: a significant deviation from the norm is determined in the smear, which indicates the presence of bacterial vaginosis and other genital infections.

Norms

Laboratory diagnostic methods in obstetrics and gynecology are an important component of assessing the health of the female body.

Among their diversity, a simple smear on the flora has stood apart for many decades.

Its other names: smear for the degree of purity, smear for GN, gynecological smear, bacterioscopy of the discharge of the genitourinary organs, microscopy of discharge from the urethra, vagina and cervix.

This study allows you to assess the composition of microflora, count the number of leukocytes and epithelial cells, and diagnose some STDs (gonorrhea, trichomoniasis).

This is a routine, non-invasive, economical and rather informative method, widely used in the work of a gynecologist.

Based on its results, the doctor is able to determine the further tactics of patient management and prescribe the appropriate treatment.

When is the analysis done?

As a rule, a smear on flora is taken at any initial visit of a woman to a gynecologist.

Also, indications for taking a smear and its subsequent microscopy are:

1. 1 Scheduled preventive examinations and medical examination.
2. 2 Pathological leucorrhoea (discharge of the vagina, cervix, urethra), their unpleasant odor, profuse character, discoloration.
3. 3 Preconception preparation in the planning of natural and IVF-induced pregnancy.
4. 4 Screening during pregnancy.
5. 5 Unpleasant, painful sensations in the lower abdomen, which the woman does not associate with the menstrual cycle.
6. 6 Painful urination, dysuria, including symptoms of urethritis, cystitis. Urological pathology in women, as a rule, requires consultation and examination by a gynecologist.
7. 7 End of taking a course of antibiotics in order to determine the nature of the flora and the possibilities of its restoration.

2. Collection of material for research

Taking a gynecological smear is possible from three points: the urethra (if necessary), the posterolateral fornix of the vagina and the vaginal part of the cervix.

The material for analysis is vaginal discharge, discharge from the cervical canal, discharge from the urethra (according to indications).

Vaginal discharge is multicomponent and includes:

1. 1 Mucus of the cervical canal - is needed for the penetration of sperm into the uterine cavity and above for fertilization. Its density depends on the level of estrogen in the woman's body; its viscosity can be used to judge the phase of the menstrual cycle.
2. 2 The secret of the glands of the external genital organs.
3. 3 Desquamated vaginal epithelium.
4. 4 Bacteria (vaginal flora). Normally, the microflora in the smear is represented by a large number of lactic acid bacteria (Doderlein gram-positive bacilli) and an insignificant amount of opportunistic flora (most often coccal).

2.1. Preparing to collect a smear

Before taking material, a woman must meet certain conditions:

1. 1 It is better to take the analysis on the 5-7th day. the collection of the discharge is not carried out.
2. 2 Avoid the use of vaginal suppositories, lubricants, douching and sexual intercourse 24 hours before the study.
3. 3 Before taking a smear, you do not need to use perfumed products for intimate hygiene; it is better to perform a toilet of the external genital organs with running water.
4. 4 It is undesirable to take a hot bath on the day of the test.

2.2. Technique of obtaining material

• A swab for flora is taken strictly before bimanual examination, the woman is on the gynecological chair.
• A bivalve mirror of the Cuzco type is inserted into the vagina, the vaginal part of the cervix is ​​exposed (removed).
• Focusing on it, the doctor with a special spatula takes material from the posterolateral fornix of the vagina and transfers it to a glass slide, which, after filling in the direction, is delivered to the laboratory for microscopic examination.
• Analysis from the external opening of the urethra is taken with a bacteriological loop or Volkmann spoon. If available, it is advisable to take exactly them, slightly pressing on the outer hole from the outside.
• Analysis from the surface of the vaginal part of the cervix is ​​taken with an Erb spatula.

3. How to decipher the results?

3.1. Normal flora

Recently, special attention has been paid to the normal composition of the vaginal microflora, since it has been proven that it is this factor that determines the reproductive health of a woman, provides local immunity, protection against pathogenic bacteria, and the normal onset and course of pregnancy.

Normally, 95% of a woman's flora is lactic acid bacteria (otherwise Doderlein's sticks, lactobacilli, lactobacilli).

In the course of their vital activity, lactobacilli process glycogen released from epithelial cells to form lactic acid. It is she who provides the acidic environment of the vaginal contents, which interferes with the reproduction of facultative and pathogenic flora.

Each woman has 1-4 species of lactobacilli in the vagina, and their combination is purely individual.

When decoding the results of the analysis, it is impossible to conduct a detailed analysis of the microflora of the vagina, the laboratory assistant assesses only the ratio of rods and cocci.

The absence of cocci and a large amount of gram-positive bacillus flora (++++) equate to 1 degree of vaginal cleanliness. This is rarely observed, this situation is more typical for control smears after vaginal sanitation or taking antibiotics.

An insignificant number of cocci (+, ++) is considered the norm and indicates 2 degrees of purity, but only if rod flora (++, +++) is also found. This is a good smear.

It is considered pathological (+++, ++++) against the background of a decrease in the number of rods (+, ++). This result is called the 3rd degree of vaginal cleanliness. This situation requires a detailed examination.

A large number of cocci (++++) and the complete absence of gram-positive rods (Gram + rods) in the smear indicate 4 degrees of purity. In this case, the woman requires compulsory treatment.

Table 1 - Normal indicators assessed when decoding the results of smear microscopy for flora and GN. To view, click on the table

3.2. Gonococci and Trichomonas (Gn, Tr)

3.7. Yeast-like mushrooms

- round-shaped unicellular microorganisms. The vaginal environment is ideal for their growth and development due to their high glycogen content.

But due to the competing lactobacillary flora, with a normal level of immunity, their active growth is not observed. For the acquisition of pathogenic properties, fungi of the genus Candida need some conditions:

1. 1 State of immunosuppression,
2. 2 The presence of endocrine pathology,
3. 3 Malignant neoplasms,
4. 4 The period of pregnancy, children and old age,
5. 5 Therapy with glucocorticosteroids.

Should not be detected. In exceptional cases, their single detection is allowed in the material taken from the posterolateral fornix of the vagina, as a component of the optional flora. It is important to take into account the presence / absence of complaints and clinical manifestations.

The detection of spores and mycelium of the fungus in a smear indicates vaginal candidiasis and requires appropriate specific treatment.

Although it is a rather informative diagnostic method, it is relevant only when comparing the result of microscopy with complaints and clinical manifestations.

The main disadvantage of this research method is the impossibility of identifying a specific causative agent of the disease. Based on the results of smear analysis, it is impossible to assess the level and depth of tissue damage.

Therefore, if an inflammatory process is detected in a smear, the doctor may prescribe additional diagnostic methods aimed at identifying the pathogen (PCR, bacteriological examination of the urinary tract discharge and determining the sensitivity to antibiotics).