Deciphering the indicators of the gynecological general smear on the flora. Detailed transcript of smear analysis for flora in women

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 do not apply to mandatory analyzes during medical 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 can provide us healthy man... 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 (gonococci, Trichomonas, yeast-like fungi of the genus Candida, etc.), which are treated, and then taken 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 (nuclei are preserved), signs of phagocytosis are absent. 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 analysis again.

Table: standards for smear results for women

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: the urethra, vagina, cervix, cervical canal.
Avda, sometimes they take an aspirate from the uterine cavity and also make smears, but this is considered a biopsy material that is reviewed 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, the doctor can count cells, detect Trichomonas, yeast, diplococci, gardnerella and other microorganisms that represent 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. Theoretically, the study of pathological changes in the cell and nucleus gives very little; here, as they say, a trained eye is needed.

Deciphering the analysis in both cases (flora and cytology) is done 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 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 that present 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 test material (cytology), indirect signs of the presence of microorganisms can be detected, 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 defeat by the herpes simplex virus (HSV);


• Cells in the form of an "owl's eye" with coarse-grained cytoplasm are characteristic of cytomegalovirus (CMV);
• With papillomavirus infection (HPV), coylocytic atypia (MPE cells with large nuclei and a zone of enlightenment around the nucleus) can be detected;
• Provacek's little bodies in the cells of metaplastic epithelium, which are characteristic of chlamydial infection and play a role in screening studies, are also indicative.

Of course, it is impossible to diagnose herpes, cytomegalovirus or 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 (ELISA, PCR, culture method, etc.). Thus, cytology allows you to narrow the range of diagnostic search, 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: do not 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 to 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 to these phenomena, similar to purulent discharge has been added, a visit 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 consists 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 the smear may contain opportunistic flora in single copies (streptococci, staphylococci, enterococci), however, 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, gonococci, 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 nowadays PCR (polymerase chain reaction);
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, urethritis, prostatitis, 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 diplococci found may turn out to be by no means 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 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 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 (obligatory), 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 sticks). The result of this "war" is the well-known bacterial vaginosis (gardnerellosis).

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 conditional, 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", other opportunistic microorganisms can be found in a smear in small quantities:

1. Gardnerella, which belongs to conditionally pathogenic flora and normally, as a rule, “sits quietly”, can be activated very quickly when the pH changes. It is often accompanied by mobiluncus, which shows its activity after gardnerella, when it captures the niche of lactobacilli, multiplies and displaces the latter. Under such circumstances, the rods leave their "possession", the flora changes, which is manifested by a significant increase in cocci in the smear. Together with gardnerella and mobiluncus, they form an abundant coccobacillary flora that covers squamous epithelial cells, and are called "bacterial sand". Such interesting MBE cells are referred to as "key cells" and are considered a diagnostic feature of bacterial vaginosis;
2. Yeast-like fungi of the genus Candida(although with rare exceptions there are other species) are also sometimes present in the biocenosis of the genital tract. The normal microflora does not allow them to reproduce especially, so they, like gardnerella with mobiluncus, are also waiting in the wings. A woman will quickly feel the reproduction of yeast fungi - itching, burning, cheesy discharge (thrush);
3. Actinomycetes- bacteria, which rarely cause inflammation, but when using intrauterine contraceptives, such troubles are quite likely. In the preparation Actinomyces are similar to blots and tangles formed by filamentous structures;
4. Leptotrix Is not one type of microorganism, it is a whole community different types coming together. They can resemble hair, lactobacilli, or simulate mycelium strands by forming a chain. In such cases, it is practically impossible to differentiate microbes without bacteriological inoculation;
5. In the female smear (faster than in the male), other opportunistic forms can also be found in small quantities. For example, Escherichia coli (Escherichia coli), Enterococcus faicalis (Enterococcus), for which there are no special obstacles in the female body, due to the anatomical structure of the genitourinary system and the close location of the lower parts of the digestive tract to it;
6. In small quantities in the genital tract, women can live staphylococci, corynebacteria, streptococci, mycoplasma and ureaplasma, however, they are difficult to detect in a smear on the flora, therefore, other methods of laboratory diagnostics are used to differentiate them.

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 are capable of provoking 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 treated in time.

This phenomenon is especially dangerous during pregnancy, since many pathogens are able to provide 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.

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 women who are healthy in gynecological terms;

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 treatment 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 expenses, and you will not have to wait long for an answer.

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When to get tested

The indications for the delivery of a gynecological smear in women are the following conditions:

• aching or paroxysmal pain in the lower abdomen, unpleasant cramps or a feeling of heaviness;
• increased secretion of mucus that smells bad;
• discomfort in the genitals - itching, burning;
• preventive examinations by a gynecologist at least once every six months;
• in the process of planning a child;
• during pregnancy.

The analysis is necessary for long-term treatment with antibacterial drugs or hormonal agents. It is important to take a smear for flora and when changing a sexual partner.

What does the smear show on the flora?

In gynecology, the analysis of the secreted fluid from the vagina shows the composition of the microflora and helps to study important indicators:

• the quantity and quality of white and red blood cells (leukocytes and erythrocytes);
• identify various cocci, Trichomonas or fungal infection;
• the number of lactobacilli.

The analysis allows you to determine the cause of a woman's malaise and choose the most effective drugs to eliminate pathological changes in the genitourinary system.

Smear rules

Proper preparation for the procedure and compliance with the requirements for the collection of biological material are integral components of reliable results.

Preparation for research

For the delivery of an analysis for the study of the microflora of the vagina, a woman needs to carefully prepare.

1. Exclude sexual intercourse within 48 hours.
2. Hygienic procedures should be carried out without special means and douching within 2 days before the test. Do not use vaginal suppositories, ointments.
3. Do not go to the toilet for 2.5–3 hours before taking the smear.

How to take a smear

The procedure for sampling biological material takes place on a gynecological chair. A gynecologist is responsible for the entire process.

1. With a disposable spatula, a spatula, the doctor removes part of the discharge from the urethra, cervical canal and vagina.
2. The material is placed on a sterile glass slide and transferred to the laboratory.

The process of collecting gynecological material does not bring discomfort to a woman and takes 5-10 minutes. The results are ready the next business day.

Norm

A healthy microflora of the genitourinary system is the presence of several leukocytes and rod flora. The basis is made up of gram-positive sticks or Dederlein sticks. They must be abundant.

Table "Reference values ​​of smear per flora"

Decoding research

The presence of pathogenic cells in the smear indicates the development of pathological abnormalities in the genitourinary system.

Depending on what microorganisms are present in the biological material, the disease is determined:

1. Blastospores. Immature pseudomycelium cells show active multiplication of the causative agents of candidiasis (thrush).
2. Increase in key (atypical) cells. Squamous epithelium begins to grow, which indicates abnormal disorders in the microflora, the appearance of bacterial vaginosis.
3. Leptotrix or leptotrichia. The cells cause degenerative changes in the epithelium and provoke colpitis (inflammation of the vagina). Pathogenic organisms can accompany the development of chlamydia, candidiasis, leptotrichiasis.
4. Coccal flora. The smear may contain gonococci, which indicates gonorrhea.
5. Trichomonas. Pathogenic cells indicate the development of a genital infection - trichomoniasis.
6. Fibrin filaments are evidence of inflammation.

When examining a smear, much attention is paid to detritus - dead cells. The substance is an integral part of a healthy microflora in both women and men. It consists mainly of a small number of obsolete epithelial cells. In the case of an increase in this indicator, we can talk about inflammation in the cervix or infectious pathologies that provoked massive death of epithelial tissue.

Evidence of pathology can be not only the appearance of pathogenic bacteria, but also changes in the quantity and quality of the constant composition of the flora.

1. A decrease in Dederlein sticks and an increase in leukocytes indicate a decrease in local immunity, the development of inflammation in the genital organs.
2. Changes in epithelial cells. If the squamous epithelium is absent, we are talking about atrophy of the uterus or cervical canal. The increase in such cells indicates inflammatory processes.
3. Excessive appearance of columnar epithelium - infectious foci in the tubes of the uterus, malignant tumors in the cavity of the genital organ or cervical canal.
4. Mucus in the cervix. Normally, there should be no noticeable discharge from the cervical canal. If there is a large amount of mucus, we are talking about severe inflammation.

Purity - what does it mean

An integral indicator of a smear on the flora is the degree of purity. The marker indicates the level of acidity and the number of disease-causing cells.

There are 4 degrees:

1. Scarce flora - Gram-positive bacilli (95%) predominate in biological material, there are few opportunistic bacteria (5%), there are single leukocytes, the environment is acidic. The woman is completely healthy.
2. Moderate flora - a large number of lactobacilli, a slight increase in leukocytes (7-10), a moderate presence of opportunistic microorganisms. The condition is not painful, but the local immunity is slightly weakened, which indicates an increased sensitivity to harmful cells.
3. Mixed flora - the number of white blood cells is increased (up to 30), the concentration of lactobacilli is reduced, the predominant presence of cocci. The medium is slightly acidic. The woman develops inflammatory processes, there is a vaginal infection.
4. Abundant bacillary environment - homogeneous mucus contains a large number of leukocytes, there are traces of phagocytosis, the complete absence of gram-positive rods. High concentration of aerobic or anaerobic bacteria. The amount of fluid released from unpleasant odor... The medium is alkaline. In the genitourinary system, pronounced inflammation, the presence of a dangerous urogenital infection.

It should be understood that if abnormalities are found that are identified by grade 3 or 4, it is important to start treatment immediately. Otherwise, the likelihood of severe complications is high.

Treatment

If the results of a smear on flora are poor, therapy is prescribed by a doctor based on the specific pathogen and its sensitivity to certain antibiotic drugs.

Table "Therapy of possible deviations in the smear on the flora"

To restore flora and strengthen local immunity, tampons and vaginal suppositories with a probiotic can be used.

The most effective are:

• Lactobacterin;
• Atzilak;
• Bifidobacterin.

Adequate treatment is prescribed exclusively by a doctor. The specialist evaluates the results of a smear on the flora and selects the most effective drugs that will eliminate the causative agent of inflammatory or infectious processes in the genital organs.

The study of a smear on flora has great importance in gynecology - a painless procedure for a woman. Microscopic examination allows you to check the condition of the vagina, uterus and urethra, identify negative deviations and identify the causative agent of pathological processes. Proper preparation and compliance with the requirements for sampling biomaterial allows you to get a reliable result the next working day.

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What is this analysis for?

Usually a vaginal swab is part of a woman's routine medical check-up. It is carried out by a specialist during a gynecological examination. Also, the collection of biological material is carried out from the urethra and cervix.

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

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

• Vaginosis or vaginitis;
• Thrush
• Trichomoniasis
• Gonorrhea

Specialists can prescribe taking a smear with the following patient complaints:

• A burning sensation and itching in the vagina.
• Soreness during intercourse.
• Unpleasant-smelling profuse discharge with discoloration.
• Pain in the lower abdomen.

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

The study also helps to identify human papillomavirus infection.

The advantages of the method:

• Painlessness of the procedure.
• Simple rules for preparing for the delivery of a smear.
• Monitoring the effectiveness of treatment of female diseases.
• Possibility of determining a variety of diseases of the genitourinary system.

For prophylactic purposes, women periodically need to carry out this diagnosis. This will help prevent possible unwanted consequences.

Preparation for delivery

Some doctors say that this analysis does not require special training, however, this is not the case. For 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, it will be difficult for the attending physician to determine the causes of your pathological condition.

Douching, vaginal suppositories and antibacterial soaps also contribute to inaccurate readings. Women need to take this analysis after the end of menstruation, and in addition, all patients should refrain from any sexual intercourse 2 days before taking the biomaterial.

How do you give up?

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

A gynecologist, obstetrician or any other medical professional lightly holds a special disposable spatula in the form of a stick along 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 the axis several times and takes an analysis. It is believed that the study does not cause pain, however, this does not exclude the doctor's negligence, as well as individual sensitivity or the presence of a particular disease, which may cause discomfort.

The meaning of 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 greatly help.

So what are these letters:

1. the reduction of the zones from which the material is taken are denoted by the letters V (vagina), C (cervical portion of the cervix) and U (urethra or urinary canal);
2. L - leukocytes, the value of which may not coincide in normal and in pathology;
3. Ep - epithelium or Pl.Ep - flat epithelium;
4. GN - gonococcus (the "culprit" of gonorrhea);
5. Trich - Trichomonas (causative agents of trichomoniasis).

In a smear, it is possible to detect mucus, indicating a normal internal environment (PH), useful Doderlein sticks (or lactobacilli), the value of which is equal to 95% of all beneficial bacteria.

Some laboratories make it a rule to put marks in relation to the content of a particular type of bacteria. For example, somewhere they use the "+" sign for this. It is put down in 4 categories, where one plus is an insignificant content, and the maximum value (4 plus points) corresponds to their abundance.

In the absence of any flora in the smear, the abbreviation "abs" is put down (lat., This type of flora is absent).

What doctors don't see on microscopy?

With the help of this analysis, it is impossible to determine such conditions or diseases of the body:

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 with separate diagnostic curettage.

2) Pregnancy. 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. You can determine the chorionic gonadotropin in urine, but not in the discharge from the genitals!

3) cervical cancer and other pathologies (erosion, leukoplakia, coylocytosis, HPV lesion, atypical cells, etc.) are determined based on the results of a cytological study. This analysis is taken directly from the cervix, from the transformation zone, according to a certain technique with Papanicolaou staining (hence the name of the analysis - PAP test). It is also called oncocytology.

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

• herpes;
• chlamydia (chlamydia);
• mycoplasma (mycoplasmosis);
• ureaplasma (ureaplasmosis);

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

Swab rates for flora

Having received the test results, it is sometimes very difficult to understand the numbers and letters written by the doctor. In fact, everything is not so difficult. In order to understand whether you have gynecological diseases, you need to know the normal indicators when decoding the analysis of a smear for flora. There are not many of them.

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

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

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

Table for decoding smear rates in women (flora)

The decoding of the results of smear analysis for flora in women is presented in the table below:

Degrees of purity by smear on flora

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

1. The first degree of purity: The number of leukocytes is normal. Most of the vaginal microflora is represented by lactobacilli (Doderlein sticks, lactomorphic types). The amount of epithelium is moderate. Mucus - in moderation. The first degree of cleanliness means that everything is normal for you: the microflora is in order, the immunity is good and you are not threatened with inflammation.
2. Second degree of purity: The number of leukocytes is normal. The microflora of the vagina is represented by useful 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 lowered and there is a higher risk of inflammation in the future.
3. The third degree of purity: The number of leukocytes is above normal. The main part of the microflora is represented by pathogenic bacteria (cocci, yeasts), the amount of lactobacilli is minimal. There is a lot of epithelium and mucus. The third degree of purity is already inflammation, which must be treated.
4. The 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. With these degrees, gynecological manipulations are allowed (cervical biopsy, curettage of the uterus, restoration of the hymen, hysterosalpingography, various operations, etc.)

The third and fourth degrees of purity are inflammation. At these degrees, any gynecological manipulations are contraindicated. You need to treat the inflammation first and then get the swab back.

What is coccal flora in a smear?

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

For a detailed description of bacteria, microbiologists, in addition to indicating their shape, size and other characteristics, stain the preparation using a special method called "Gram stain". Microorganisms that remain stained after washing the smear are considered "gram-positive" or gr +, and those that discolor when washed are "gram-negative" or gr-. Gram-positive ones include, for example, streptococci, staphylococci, enterococci, and lactobacilli. Gram-negative cocci include gonococci, Escherichia coli, Proteus.

What are Doderlein sticks?

Doderlein sticks or, as they are also called, lactobacilli and lactobacilli are microorganisms that protect the vagina from pathogenic infections by producing lactic acid, which helps to 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 its shift to 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 pathogens (which are sometimes found in the vagina normally).

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

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

The flora in a woman can change for a variety of reasons - with a decrease in immunity, taking antibiotics, with general infectious diseases and diabetes mellitus... One of these factors that can change the microflora is a change in hormonal levels. So, a pregnant woman practically does not produce estrogens until the end of pregnancy, but the hormone progesterone is produced in large quantities. This hormonal background allows Doderlein's sticks 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 and identify the degree of cleanliness of the vagina before the planned pregnancy. 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 an incomplete list of diseases that weaken and loosen the walls of the vagina. This is dangerous because ruptures can occur during childbirth, which might not have been if the vagina was clean and healthy. Diseases such as mycoplasmosis, chlamydia and ureaplasmosis are not detected during smear analysis, and these pathogenic microorganisms can only be detected by analyzing blood by PCR (polymerase chain reaction), using special markers.

A smear analysis of a pregnant woman is taken during registration, and then for control 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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When is the analysis done?

A flora smear is part of a routine medical check-up for women. It is performed during a pelvic exam. The material is taken from the urethra and cervix. The diagnostic method allows you to detect the development of infectious or inflammatory diseases. In medicine, research has a different name. It is called bacterioscopy.

A woman may be referred for a smear test for flora if there is a suspicion of thrush, gonorrhea, vaginosis, trichomoniasis, or vaginitis. The study is also prescribed if the patient has the following complaints:

• pain localized in the lower abdomen;
• the patient is worried about itching and burning in the vagina;
• abundant discharge with an unpleasant odor is observed;
• during intercourse, a woman feels soreness.

The study is carried out during pregnancy, as well as after antibiotic therapy. The smear makes it possible to effectively control the therapy that is carried out in the treatment of gynecological diseases.

The procedure is not associated with painful sensations. Preparing for a smear test is very simple. The study makes it possible to identify a large number of diseases of the genitourinary system. Doctors recommend undergoing this type of diagnosis for preventive purposes. The method will help to identify in advance the onset of the development of the disease and prevent it in the bud.

Smear rules

The smear can be taken on any day of the cycle except for the menstruation itself. Bleeding affects the bottom line. It can lead to a false positive or false negative result. The best day to take a smear is the moment before the onset of a new cycle. The sampling of material can be performed in the first days of a new cycle.

Before taking the analysis, it is recommended to completely exclude sexual intercourse, use local preparations in the examination area and the implementation of douching. On the day of the study, hygiene measures of the genitals should not be carried out. It is not recommended to urinate several hours before taking a smear.

If a smear is taken for sterility, most often the doctor asks the woman to put a tampon overnight and leave it for 8 hours. Then it is removed in the morning at a specialist's appointment.

Carrying out an analysis for cytology requires compliance with all of the above rules. With this type of examination, it is necessary to exclude the presence of an inflammatory process in the vagina. If it takes place, first of all, it is stopped and only then the material is taken for research. The analysis will be able to show a true result only if the material is taken before a gynecological examination, colposcopy or ultrasound. If they were performed initially, the smear is taken 2 days after the procedure.

If tests for latent infections are performed, preparation may vary on a case-by-case basis. In addition to following the basic rules, a so-called provocation can be performed. In this situation, the study will show the most accurate result.

Attention is also paid to nutrition. On the eve of the test, you can eat foods that enhance the activity of pathogenic microorganisms. The list includes:

• spicy;
• salty;
• a small amount of fried and fatty.

However, overeating until you feel unwell is not worth it. Before going to the doctor, in addition to the standard set, you must purchase a special special brush at the pharmacy. This will allow the specialist to take the material as efficiently as possible.

The very process of taking a smear is not difficult. The woman will have to be accommodated in a gynecological chair, after which the specialist will take a smear from the vaginal mucosa or cervix. The resulting material is applied to a glass slide or placed in a test tube.

Swab rate for flora (table)

When the research is done, the woman will be able to get the results. There are not so many indicators in a smear for flora. Normally, they should have the following meanings:

1. Dederlein sticks. An adult woman should have a lot of them. If there are few lactobacilli, this indicates a disturbed vaginal microflora.
2. Slime. It may be present in the smear, but in moderation.
3. Squamous epithelium. Normally, there should be no more than 15 cells in the field of view. If the value of the indicator is exceeded, this indicates the development of inflammatory diseases. If the amount of squamous epithelium in the smear is less, this signals the presence of hormonal disorders.
4. Leukocytes. The presence of these cells in the smear is allowed. They fight infection. Normally, the number of leukocytes in the vagina and urethra should be no more than 10 in the field of view. If a smear is taken from the cervix, the value of the indicator can be increased to 30.

The test results should not contain gonococci, small rods, Trichomonas, candida fungi or other microorganisms. If they take place, this may indicate the development of the disease.

Letters on the Analysis Form

For convenience and to speed up the process of filling out the analysis form, abbreviations are used. The following letters may appear in the research results:

1. V (vagina), C (cervical portion of the neck) and U (urethra or urinary canal). These abbreviations designate the zones from which the material is taken.
2. GN - gonococci. Microorganisms provoke gonorrhea.
3. Ep - epithelium or Pl. Ep - flat epithelium.
4. L - leukocytes. By their number, the doctor may suspect the development of pathology.
5. Trich - Trichomonas. Microorganisms provoke the development of trichomoniasis.

Mucus can be found in the smear, which indicates a normal internal environment, as well as Dederlein sticks. Their number should be 95% of all beneficial bacteria.

In some laboratories, labels are put down for a specific type of bacteria. So, if the presence of this or that microorganism is confirmed, a plus is placed opposite its designation. In case of absence, a minus can be put down or an empty column can be left. The pros are sorted into four categories. One character means a low content of microorganisms. The maximum number is 4 plus. If any flora is missing in the smear, the abbreviation abs can be used.

Coccal flora

Cocci are spherical bacteria. They can be present normally or in various inflammatory diseases. In a healthy woman, single cocci are found in a smear. If their number increases, this may indicate a decrease in immune defense. Cocci are positive and negative.

Describing bacteria in detail, microbiologists indicate not only the shape, size and a number of other characteristics, but also the staining of the preparation using a special method. It received the name Gram stain. If the microorganisms remain stained after washing the smear, they are considered positive. In this case, their designation is gr +. Microorganisms that are discolored during washing are considered gram-negative. They are designated as gr-.

Dederlein sticks

Dederlein sticks are called microorganisms that protect the vagina from the penetration of pathogenic infections. For this, the production of lactic acid is carried out. With its help, an acidic environment in the vagina is maintained, which contributes to the destruction of pathogenic microflora. If there is a decrease in the number of Dederlein sticks or lactobacilli, as they are also called, this indicates a disturbed acid-base balance of microflora. At the same time, it shifts to the alkaline side. This phenomenon is often observed in women who are sexually active. The acid-base balance of the vagina can also change under the influence of pathogenic and opportunistic microorganisms.

Leptotrix

Microorganisms in this category are opportunistic. Leptotrix is ​​the name given to gram-positive anaerobic rods that inhabit water bodies. Under a microscope, they look like hair.

It is believed that sexual transmission of leptotrix is ​​not carried out. If no other abnormalities are found, the presence of these microorganisms in the smear should not cause concern. A feature of leptotrix is ​​the fact that they often accompany Trichomonas and Chlamydia. If a microorganism is detected in a woman's smear, the doctor will prescribe medications to get rid of several pathogens at once.

If leptotrixes have been identified during pregnancy planning, treatment is mandatory. It has been proven that the microorganism is capable of provoking a miscarriage, causing the development of inflammatory processes in the membranes and infecting a child.

Purity

Depending on the results of the smear, 4 degrees of vaginal purity are distinguished. They depend on the state of the microflora. The list includes:

1. First degree of purity. The number of leukocytes remains normal. Moreover, most of the microflora is represented by lactobacilli. The amount of mucus and epithelium is moderate. If, according to the results of the analysis, it turned out that a woman has 1 degree of vaginal cleanliness, this indicates that no abnormalities were found. The microflora is fine. Women have good immunity and there are no signs of inflammation.
2. 2 degree of purity. The number of leukocytes is also normal. The microflora of the vagina consists equally of lactobacilli and cocci or yeasts. The amount of epithelium and mucus is also moderate. 2 degree of purity also applies to the norm. However, the composition of the microflora is no longer ideal. This indicates a decrease in local immunity. The risk of developing pathology in the future increases.
3. 3 degree of purity. Leukocytes exceed the permissible norm. Most of the microflora is disease-causing bacteria. At the same time, the number of lactobacilli is minimal. A large amount of mucus and epithelium is observed in the smear. 3 The degree of purity indicates the development of inflammation. It requires treatment.
4. 4 degree of purity. There are a lot of leukocytes. In this case, lactobacilli are absent. There is a lot of epithelium and mucus. If a woman has a grade 4 purity, this indicates the presence of severe inflammation. Pathologies require immediate treatment.

Grades 1 and 2 are considered the norm. With them, various gynecological manipulations can be performed. 3 and 4 degrees of purity occur with inflammation. The woman should undergo treatment and then re-take the smear.

Flora smear during pregnancy

In pregnant women, there is a change in the microflora of the vagina. It is influenced by hormonal levels. Estrogen is not produced until the end of pregnancy. At the same time, a large amount of progesterone is produced in the body. As a result, there is an increase in the number of Dederlein sticks. Their number increases 10 times. In this way, the body tries to protect the fetus from possible infection.

The weakening of the body increases the likelihood of pathologies. Trichomoniasis, candidiasis, gonorrhea, bacterial vaginosis, or gangrenellosis can weaken and loosen the vaginal walls. This is dangerous due to the occurrence of ruptures during childbirth. For this reason, during pregnancy, a woman must undergo a smear test for flora. However, it should be borne in mind that ureaplasmosis, mycoplasmosis and chlamydia cannot be determined using an analysis. The above pathogenic microorganisms are detected only by blood analysis by PCR, as well as with the help of special markers. A smear analysis of a pregnant woman is taken during registration, then at 30 and 38 weeks. The action is performed to control the state of microflora.

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Indications for smear analysis for flora

Taking a gynecological smear on the flora is advisable if women have such clinical manifestations:

1. Change in normal color and odor in vaginal discharge.
2. Pain syndrome in the lower abdomen, both at rest and during sexual intercourse.
3. Burning, itching in the genital area.

In addition, swabs for flora are taken when:

• preventive examinations;
• during pregnancy, once every trimester;
• antibiotic therapy to exclude candidiasis.

The attending physician should decipher the analysis of a smear for flora after receiving the results of the study from the laboratory.

It should be noted that the indicators of the analysis of microflora can change not only with any pathologies. Fluctuations in values ​​are observed when the hormonal background changes during puberty, during pregnancy, during menopause. In addition, changes in the smear of adult patients can cause contraceptive drugs, neglect of personal hygiene rules, and sexual activity. Minor fluctuations are possible depending on the phase of the menstrual cycle.

Important! But the appearance of any pathogenic microorganisms is a signal of the presence of a disease or (less often) of a carrier. Detection of pathogens requires specific therapeutic measures.

Study preparation rules

To obtain reliable results of a smear test on flora, it is necessary to adhere to the following restrictions:

• exclude sexual intercourse two days before the sampling of the biomaterial;
• do not use vaginal suppositories, ointments, creams two days before taking a smear;
• do not resort to douching;
• carry out personal hygiene measures by taking a shower, not a bath;
• do not urinate several hours before visiting a doctor.

It is important to strictly adhere to these rules so that the result of a smear on flora is informative.

Swabbing procedure

Taking a smear on the flora in women is performed by a gynecologist at the reception. In addition, biomaterials can be donated to private laboratories. The procedure for taking a smear itself consists of the following stages:

1. The woman sits on the gynecological chair.
2. For better access to the walls of the vagina and cervix, sterile speculum is inserted.
3. Collection of biomaterial from the vaginal wall. The manipulation is painless, but unpleasant sensations can be observed with inflammation.
4. The material is applied to the slide using strokes and as thin as possible.
5. Fixation of the smear. It is necessary in cases where the smear will be delivered to the laboratory more than 3 hours after taking.
6. Delivery of the smear to the laboratory.
7. Glass color. The most commonly used dye is methylene blue.
8. Microscopic examination of the smear, which is carried out by a doctor of clinical laboratory diagnostics. The specialist determines the increased leukocytes in the cervical canal, assessing the composition of the flora. Reveals the degree of cleanliness of the vagina.
9. Sending the results obtained to the gynecologist.

More often biomaterial is taken from three points:

• a smear on flora from the cervical canal;
• a smear from the vaginal walls;
• smear from the urethra and paraurethral canals.

Due to the anatomical proximity of the listed areas, the infectious and inflammatory processes of these areas are often interconnected. To take material from each area, the doctor takes a separate sterile instrument and makes three smears on separate slides.

After sampling the biomaterial, there is no need for any restrictions for the woman. You can swim in the bathtub, swim in water bodies, sexual intercourse is allowed.

Decoding of the obtained results

To indicate the localization of taking the material, the letters of the Latin alphabet are used: V, C and U. The letter V stands for the vagina, C for the cervical canal, and U for the urethra. To understand the interpretation of the data obtained during the study, it is necessary to figure out which microorganisms can be detected when analyzing a smear for flora.

Coccal flora

Coccal microorganisms have a rounded shape and can be found in smears both in normal conditions and in pathology. When staining the material by the Gram method, gram-positive and gram-negative cocci are detected. The appearance of gram + cocci in a smear is permissible - they can be streptococci and staphylococci. Gram-negative cocci are often pathogens - these include gonococci, which provoke gonorrhea.

Doderlein sticks

The rod flora in the vagina is the most important indicator of the health of the female reproductive system. Under Doderdain's rods, large immobile rods are united, which belong to gram-positive microorganisms. They are essential to ensure a healthy vaginal flora.

Among the functions of Doderdain's sticks (or lactobacilli), the following should be distinguished:

1. Maintaining an acidic reaction of the environment in the vagina, which is also necessary for correct fertilization: weakened male germ cells die, and strong ones can overcome the barrier and fertilize the egg.
2. Suppression of the multiplication of pathogens as a result of macrophage activation.
3. Keeping the vagina clean by releasing hydrogen peroxide.

Normal flora values ​​include a large number of Doderdain sticks. A decrease in their number can signal serious problems in women's reproductive health.

Leptotrix

Leptotrix is ​​a conditional pathogen. It is an anaerobic gram-positive bacillus. With microscopy, this microorganism is easy to distinguish - it looks like a thin and long rod in the form of a hair.

An important feature of leptotrix is ​​that this microorganism is often detected simultaneously with serious pathogens - chlamydia and Trichomonas. If leptotrix is ​​found during pregnancy planning, treatment is prescribed without fail.

The rate of smear on the vaginal microflora

To make it easier to understand the results obtained, you need to know which indicators are considered the norm. So, normally, the decoding of the smear analysis assumes:

1. Squamous epithelium - up to 15 cells are allowed in one field of view. An increase in the number of squamous epithelial cells indicates the presence of an inflammatory process, and a decrease in hormonal imbalance.
2. Leukocytes in the cervical canal - the norm of leukocytes in a smear for flora is considered to be up to 10 in the field of view, in the urethra - up to 5, and in the cervix - up to 30.
3. Doderlein sticks are normally contained in a smear in large quantities.
4. Mucus in the biomaterial should be present in small quantities.

The detection of Candida fungi, gram-negative cocci, gonococci, small rods, Trichomonas in the material is an indication for additional studies (bacteriological analysis and other diagnostic methods) and subsequent complex treatment.

The table below shows the main indicators of a smear on flora.

Table: What the result of a smear on flora shows

Leukocytes in a smear for flora

An important step in gynecological diagnostics is the assessment of the degree of vaginal cleanliness. There are four possible degrees, the first two of which indicate the norm, and the third and fourth - confirm the presence of a pathological process. The characteristics of each of the degrees are presented below:

1. Leukocytes and epithelial cells in normal numbers. A large number of Doderlein sticks, mucus in a small amount.
2. Leukocytes are within normal limits, a large number of lactobacilli, a little coccal flora, the presence of Candida fungi is possible ..
3. A lot of mucus and epithelial cells - a lot of leukocytes in a smear on the flora. There are few Doderdain sticks, the predominance of coccal flora, the presence of fungi, pathogenic microorganisms is possible.
4. The number of leukocytes is greatly increased. Lack of Doderdain sticks. A large number of epithelial cells and mucus. Detection of pathogenic microorganisms.

The third and fourth degrees of vaginal cleanliness require the appointment of therapeutic measures.

Features of a smear on microflora during pregnancy

A smear test for flora is carried out once in each trimester of pregnancy: at registration, at the thirtieth week and immediately before the expected date of delivery. The analysis is necessary as a preventive measure to identify pathologies that can complicate the course of pregnancy and childbirth, as well as provoke an illness in a child.

Important! The change in the indicators of the study of flora in a pregnant woman is explained by the restructuring of the hormonal background - the level of progesterone increases and the level of estrogen decreases.

The indicators of the analysis of microflora in a pregnant woman have little difference from those in a non-pregnant woman. However, there are still differences and you need to know about them:

1. Increase in the number of Doderlein sticks. Physiologically, this is necessary to protect against various pathogens and prevent the penetration and development of infection.
2. An increase in the number of epithelial cells in a smear.

When pathogens are identified, the doctor prescribes sparing methods of treatment, specific of which are selected depending on the trimester and the characteristics of the clinical case. External remedies are more often used - ointments, suppositories or tampons.

When deviation of results from the norm is possible

An increase in the number of leukocytes in combination with an increase in the amount of mucus and epithelial cells indicates the presence of an inflammatory process, or such pathologies:

• urethritis;
• vulvovaginitis;
• vaginitis;
• colpitis;
• cervicitis;
• adnexitis (salpingo-oophoritis).

If only the number of epithelial cells in the smear increases in isolation, then this is permissible when the level of estrogen increases during the menstrual cycle. The case when the number of epithelial cells decreases, speaks of menopause or hormonal imbalance. A large amount of mucus indicates either inflammation or poor personal hygiene.

Mixed flora, that is, the presence of both rods and cocci in a smear, can be a variant of the norm at the age of 14 years and in menopause. In other cases, a mixed flora can speak of an inflammatory process, ovarian hyperfunction, the beginning or end of menstruation, as well as venereal pathologies.

Coccal flora is found in inflammatory pathologies of the urethra or vagina, with bacterial vaginosis. Finding key cells in the smear also confirms bacterial vaginosis.

A smear from the cervical canal normally suggests the absence of flora, key cells, pathogens, the number of leukocytes up to 30 in the field of view and a moderate number of epithelial cells, deviations from these values ​​indicate pathology.

Identification of pathogens is a signal to the doctor about the need for additional tests and subsequent treatment. In particular, bacteriological examination may be necessary, as well as analysis using polymerase chain reaction (PCR). PCR is necessary to detect the DNA of those pathogens that cannot be detected in a smear - namely, mycoplasma, ureaplasma, chlamydia. You may also need a study for gonorrhea - the doctor prescribes a referral for "analysis for gn".

The microflora of the vagina, a smear from the cervical canal and urethra can change not only in the case of infectious and inflammatory processes. This is possible with erosion, pathologies of the immune system, antibiotic therapy, and metabolic diseases. Any deviation from normal values ​​is an indication for a more detailed diagnosis.

Now it is easy to get a transcript of the analysis for microflora in women online, however, it is still better to entrust the interpretation of the data obtained to a specialist in whom the patient is being observed. Deciphering a smear on flora online is possible, but it is recommended to consult a doctor, especially in case of deviations from the norm.

Regular visits to the gynecologist and analysis of indicators of the microflora of the vagina, cervical canal and urethra are necessary to maximize early detection dangerous diseases and the appointment of appropriate treatment. It is important to follow all the recommendations of a specialist and take repeated tests if necessary.

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A smear on the flora in women - which shows

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

In what cases is the analysis of a smear for flora

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

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

For women, the question arises: how long does it take to analyze a smear for flora? It will be ready in 1 day.

How many smear tests are valid for flora

The analysis result is valid for 10 days.

How to correctly pass a smear for flora

Preparation for taking a smear on flora

Special preparation for a smear on flora in women is not required. There are only a few points to pay attention to. For two days before taking the test, a woman should not use any vaginal products, including suppositories and lubricants. Also, within 3 days, you should refrain from sexual contacts, taking a bath, douching. Remember that the procedure cannot be performed during your period.

How is a smear taken on the flora in women

On the day of taking the material for analysis for vaginal hygiene, you can not use anything other than the usual washing with warm water without soap. Urination is undesirable two hours before the procedure. The gynecologist first examines the walls of the vagina and the cervix using mirrors, then using a special spatula or cotton swab takes material from 2 areas - the vagina and cervix, and then from the urethra. The resulting material is applied to 3 sterile slides marked: V (swab from the vagina), C (swab from the cervical canal), U (swab from the urethra). The gynecologist dries the glass and sends it to the laboratory for examination, where the smears are stained and determine what microflora is present.

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

Taking a smear from a virgin

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

A smear on flora - norm and pathology

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

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

Lactobacilli are not the only type of microorganisms that make up the microflora of a healthy woman. Candida and gardnerella may also be present normally. But their number should be quite small. Under the influence of some factors (prolonged stress, overwork, pregnancy, illness), the body's immune defenses are weakened. In such conditions, these organisms multiply rapidly, and vaginal dysbiosis (bacterial vaginosis), candidiasis (thrush), gonorrhea, chlamydia, ureaplasmosis, mycoplasmosis and gardenrellus develop.

Swab for flora (table of norms)

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

A smear on flora: decoding of indicators

In order to save time in medical practice, abbreviations are used to indicate smear analysis indicators. Latin letters V, C, U are usually used to designate areas from which material for analysis is taken.

V - vagina (Latin for vagina).
C - cervical canal (cervix).
U - urethra (uretra).

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

L - leukocytes. These cells are present in both healthy women and sick women. If there is a disease, the number of leukocytes increases.

Ep - epithelium. Also there is the designation "pl. ep. ". This means squamous epithelium.

Trich - Trichomonas. It is an organism that causes a disease called trichomoniasis.

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

In addition, smears often contain mucus. This suggests that the pH of the vagina is within the normal range.

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

If any organism is not found at all, mark "abs", which means "absent."

Doderlein sticks in a smear

This is the second name for lactobacilli, organisms that form the natural flora of the vagina. These bacteria secrete lactic acid, which retains the acidity necessary to neutralize disease-causing microbes.

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

Cocci are spherical microorganisms. These bacteria are found in both healthy women and those with inflammatory diseases. The presence of a few cocci in the smear is considered the norm. When the immune system weakens, the number of cocci begins to increase dramatically. They can be gram-positive and gram-negative.

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

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

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

To clarify the diagnosis, you may need to take a smear for culture.

Epithelium in a smear for flora

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

Key cells in a smear in women

Key cells are epithelial cells surrounded by a small rod. Normally, they should not be. And in case of pathology, they are found in a smear, this indicates that aerobic lactobacilli have been supplanted by anaerobic microorganisms, including small sticks. This condition is called bacterial vaginosis.

Mushrooms in a smear

Mushrooms can be present in small quantities and do not cause symptoms of the disease. This is in the event that fungal spores are found under the microscope, if hyphae, fungal mycelium are found, then there will be a widespread candidiasis with bright symptoms.

Trichomonas are large unicellular organisms with flagella. Under the microscope there may be
whole or destroyed microorganisms. This indicates a trichomoniasis infection.

Trichomonas are shown by arrows

The norm of leukocytes in a smear for flora

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

Table of norms for the content of microorganisms in a smear

Flora smear during pregnancy

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

In pregnant women, a smear for the flora is taken repeatedly. The first time a woman registers, then at 30 and 38 weeks. Thus, the vaginal microflora is monitored for the entire period of pregnancy. Pregnant women, due to hormonal imbalance, often have vaginal candidiasis. If "strange" discharge appears during pregnancy, you should definitely contact your attending gynecologist.

The degree of cleanliness of the vagina

To assess the state of microflora, the concept of "vaginal cleanliness" is used.

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

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

With the third degree of purity of the vagina, there are more opportunistic microorganisms in the smear than lactobacilli, and this indicates the presence of an inflammatory process, the pH of the vagina is alkaline or neutral. In the smear, leukocytes (10 - 30) and epithelial cells are determined. A woman may be disturbed by pathological discharge, itching and burning in an intimate place.

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

With the third and fourth degrees of vaginal purity, drug treatment is required using broad-spectrum antibiotics. Antibacterial therapy it is prescribed taking into account the sensitivity of pathogenic microorganisms.

Deciphering the results of a smear on flora in women

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

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

If the smear contains cocci, small sticks and "key" cells, then the gynecologist diagnoses bacterial vaginosis.

When a gonococcus is detected, a diagnosis of gonorrhea is made. If gardnerella and Trichomonas are found, then the patient has gardnerella and trichomoniasis. Large numbers of Candida are indicative of deterioration in cleanliness and dysbiosis. In this case, the number of Doderlein sticks usually becomes less compared to pathogenic ones, and the doctor diagnoses vaginal candidiasis.

conclusions

The results of a smear analysis for flora in women during a routine examination allow us to assess the work of the immune and hormonal systems, identify vaginal dysbiosis, diagnose chronic inflammatory diseases of the genitourinary organs and sexually transmitted infections. With a "bad" smear on the flora, the gynecologist can promptly prescribe additional examination methods and select the required treatment.
A “good” smear on flora will give a woman peace of mind and confidence that everything is in order in terms of women's health, so it is so important to undergo a gynecological examination once every six months.

A smear on flora is an informative study for the detection of gynecological diseases.

The analysis result includes several parameters, each of which must be within the limits acceptable standards.

What should be the flora in a smear in women, including during pregnancy? What is considered the norm in the analysis, how to decipher the indicators (the level of leukocytes, squamous epithelium, erythrocytes, etc.)?

The need for analysis

Flora smear surrendered at every visit to the gynecological office. The indications for its delivery are quite extensive.

Research can be done when a woman has troubling symptoms or as a preventive measure.

Basic indications delivery of a smear:

• planned visit to the gynecologist;
• change in the nature of the discharge;
• pregnancy;
• checking the response to taking antibiotics;
• preparation for gynecological procedures or surgery;
• pain in the lower abdomen.

When visiting a gynecologist, a woman should inform about the regularity of the menstrual cycle. Mention should be made of the nature of vaginal discharge, the intensity of painful sensations and other signs.

After the interview, the doctor examines the patient on the gynecological chair. A sample of vaginal secretions is taken with special instruments.

The study of the obtained material is carried out in laboratory conditions. It can take several days.

The result shows the number of pathogenic microbes and beneficial bacteria.

Depending on the result obtained, a diagnosis is made. Vaginal secretions assigned one of four possible degrees of purity.

First two degrees are considered a good result.

Third degree indicates the onset of the inflammatory process.

The last stage indicates a serious illness. infectious or inflammatory.

Normal indicators

In a healthy female body, all the obtained analysis indicators should correspond to the norm. Minor deviations are sometimes possible.

The attending physician should deal with the decoding of the result., only he is competent in making a diagnosis.

Fertile boundaries

The boundaries of the permissible norms of a gynecological smear on the flora from the vagina in women in the following table:

Increased white blood cell count indicates an inflammatory disease. In this case, the amount of squamous epithelium will simultaneously increase.

Mucus in a smear speaks of the development of an infectious disease.

A healthy patient should not have Trichomonas cells, fungi, key cells, and gonococci. Their presence speaks of the corresponding disease.

The presence of key cells is a sign of vaginal dysbiosis.

Gonococci in a smear indicate infection with gonorrhea. Mushrooms indicate the development of thrush.

When in a smear, Trichomonas will be detected.

Results in pregnant women

The norms for pregnant women have been slightly changed... The fact is that due to a decrease in immunity, some deviations in this case are considered acceptable.

The number of leukocytes can reach 20 units... The rest of the smear must comply with the standards.

Candida fungi are present in the vaginal secretions of a pregnant woman. This indicates the development of thrush.

Various factors can affect the growth of fungi.... For example, excessive consumption of starchy foods, stress, weight gain and pregnancy.

In medical practice, it is customary to regard the appearance of candidiasis as an indirect sign of successful conception.

What to do if there is a discrepancy

Treatment depends on the composition of the woman's microflora. Infectious diseases eliminate by taking medications.

Against thrush prescribe medicines containing Clotrimazole.

It is customary to treat the inflammatory process anti-inflammatory drugs.

Vitamin therapy can be used at the same time.

To avoid disruption of the microflora composition, preventive measures should be followed:

• use of PH-neutral products for intimate hygiene;
• balanced diet;
• do not abuse douching;
• having a permanent sexual partner;
• lack of stress;
• regular visits to the gynecological office.

The effect of the diagnostic procedure will be greater if you follow the rules of preparation for the analysis.

Sexual intercourse and taking antibiotics the day before are contraindicated. It is not recommended to use medications in the form of suppositories and ointments.

Subject to all conditions, this study may be revealing enough... Otherwise, re-delivery of the biomaterial will be required.

Vaginal microflora Is a complex biosystem that includes a whole complex of microorganisms. To assess its condition, a calculation is carried out both in quantitative and qualitative proportions.

The bacterial composition can change as the female body matures and sex hormones have a great influence on it.

The entire flora can be subdivided into several types:

• Obligate flora, without which the existence of normobiocenosis is impossible. It includes, first of all, lactobacilli or Dederlein's sticks. They represent the majority of the vaginal landscape both in percentage and in quality. To maintain the desired pH, it is required that lactobacilli be at least 98% of the total number of bacteria. It is due to their vital activity that an acidic environment of the mucous membrane is created. This group can also include bifidobacteria, their number is usually insignificant.
• To opportunistic flora should include a large group of microorganisms, which consists of cocci, as well as other bacteria. These are mainly streptococci, staphylococci, enterobacteria, etc. With a small amount they do not manifest themselves clinically, but with an increase in the content they appear in most cases as a clinical picture of the inflammatory process.
• To absolute pathogens include primarily the causative agents of sexually transmitted infections. If it gets on the mucous membrane of the genital organs, it leads to the development of a pathological process and subsequently leads to the development of serious complications. This group should include, first of all, gonococci and Trichomonas, these are the main microorganisms detected in the smear and requiring the appointment of therapy.
• A small group of representatives of the flora is made up of mushrooms. They are represented by the genus Candida, in small quantities contained in the vagina. But with an increase in the amount, they lead to the development of an inflammatory process.

When should a woman have a swab for flora?

A woman is recommended to take a smear for flora at each visit to a gynecologist, in addition to the general diagnostic and preventive purpose, using this method, it is possible to identify those diseases that are diagnosed much earlier than symptoms appear.

Indications for taking a smear are:

Each specialist performing the reception can take the material.

How to Prepare?

In order to obtain reliable analysis results, you need:

How is a smear taken?

The optimal time for sampling is the middle of the menstrual cycle:

Analysis cost

A swab for flora is performed in any budgetary institution absolutely free of charge, since this method is one of the screening and mandatory ones. In addition, this is the minimum examination of a woman with a preventive purpose.

In private clinics, the cost of such an analysis can be about 200-300 rubles... The smear will not always be free only at the antenatal clinic, it can be done free of charge.

What is the difference between a smear for flora and bacterial culture?

Many women are interested in the question about the differences between bacterial culture and smear on flora, whether they are the same analysis, and also whether there is a difference between them.

A smear on flora - this is an examination of the contents under a microscope. For this, the material is taken, after which it is fixed with special dyes and substances, such as ethyl alcohol. Microorganisms are thus killed, and only those that come into view are counted. In this case, you can see only leukocytes, erythrocytes, the qualitative composition of microflora, as well as the presence of specific pathogens.

— This is a type of laboratory study in which the growth of microorganisms is determined, as well as the specification of sensitivity to antibacterial agents. For this, the material obtained from the woman is placed on a special nutrient medium, not allowing it to dry, as well as with the presence of nutrient material for the possible nutrition of the bacteria.

The method is not common, as it is considered quite expensive. At the same time, its effectiveness is quite high, this is due to the fact that in some cases a small number of bacteria may not be noticed, and during their growth, the formed colonies are easily identified.

It also helps to find the most suitable treatment. This is especially important in the presence of a recurrent process, as well as the determination of a specific pathogen.

The degree of cleanliness of the vagina

According to the results of a smear on the flora, its condition is assessed. The main indicators in this case are Dalerlein sticks, leukocytes, epithelial cells, as well as other representatives.

Conventionally, the state of the environment is usually divided into 4 degrees:

• 1st degree means the full health of a woman from the side of microflora. It is represented only by obligate microorganisms such as Daderlein's sticks and lactobacilli. It is they who contribute to the acidification of the environment, which prevents the reproduction of other flora. In this case, leukocytes, microbes, as well as erythrocytes and pathogenic microorganisms will not be observed.
• At grade 2, the most frequent group in women who are sexually active, there is not only obligate microorganisms, such as lactobacilli, but also single cocci. It is possible that leukocytes may appear, in an amount of no more than 10 pieces. Epithelial cells should not exceed 5. This cannot be considered a pathology, since lactobacilli cope with their function, the inflammatory process does not occur, but this flora can come from contact with a sexual partner. Cocci are normally found on the glans penis.
• At grade 3 already there is an inflammatory process in the vaginal environment. This is due to the fact that there is a change in the environment, it becomes alkaline, not acidic. Lactobacilli decrease in number, and such microorganisms as streptococci, staphylococci, fungi and Escherichia coli, on the contrary, increase. The inflammatory process is also confirmed by increased leukocytes, there are more than 30 of them in the field of view. In this case, a woman may complain of the appearance of pathological symptoms such as itching, burning and discharge from the genital tract.
• At 4 degrees the inflammatory process is already pronounced, there is a manifestation of dysbiosis, which is also called bacterial vaginosis. In this case, the medium will always be alkaline, shifted almost as much as possible in this direction. At the same time, lactobacilli are absent, and the flora is represented by a pathogenic group of microorganisms. Representatives of sexually transmitted infections can often be seen, although there may be nonspecific ones. The number of leukocytes increases significantly, it can reach 50 or more. At grade 4, compulsory treatment is required even without the absence of symptoms on the part of the woman.

Deciphering smear results

In a smear on flora from the cervical canal, no coccal flora should be found at all.

Coccal flora on the vaginal mucosa is represented by both gram negative and gram positive microorganisms.

This is due to the fact that some bacteria are capable of staining with a special dye that has a dark blue or purple color. A gram positive microorganism in this case has a dark blue color, but negative ones have a lighter pink.

Scientists have found that those bacteria that do not have the ability to stain are more resistant to the action of antibacterial agents. This will be due to the fact that they have a thick wall, so the dye, as well as the drug, is more difficult to penetrate into the cell cavity.

The most common gram positive include staphylococci and streptococci, which do not always give an inflammatory process in the vagina. And in a smear on the flora, they are contained in a single amount.

Gram negative flora more often causes vaginal disease. The most famous coccus is considered gonococcus.

In the absence of symptoms of pathology, the presence of leptotrix does not require additional treatment, but if even a minor clinic develops, drug therapy is prescribed. The frequency of occurrence of this bacterium increases in the presence of HIV infection.

Decoding indicators

Indicator decoding table

Flora smear during pregnancy

It is indicated for all women who have been diagnosed with pregnancy. This is due to the fact that the course of pregnancy, as well as the development of the fetus, largely depends on the state of local immunity. The minimum is considered to be a double sampling of material.

As a result, it can be concluded that this smear will be a very important diagnostic minimum to prevent complications, since with timely diagnosis it is possible to prescribe a treatment that can normalize the condition.

How to maintain vaginal microflora?

To maintain a normal microflora, a woman needs to follow several rules:

A flora smear is one of the most informative studies carried out to detect gynecological diseases.

The analysis result includes several parameters, each of which must be within the acceptable limits.

In this article, we will tell you what the flora should be in a smear in women, including during pregnancy: what should be considered the norm in the analysis, how to decipher the indicators (the level of leukocytes, squamous epithelium, erythrocytes, etc.).

Research can be done when a woman has troubling symptoms or as a preventive measure.

The main indications for passing a smear are as follows:

• planned visit to the gynecologist;
• change in the nature of the discharge;
• pregnancy;
• checking the body's response to antibiotics;
• preparation for various gynecological procedures or surgery;
• painful sensations in the lower abdomen.

When visiting a gynecologist, a woman should inform about the regularity of the menstrual cycle. You should also mention the nature of vaginal discharge, the intensity of painful sensations and other signs.

After the interview, the doctor examines the patient on the gynecological chair. A sample of vaginal secretions is taken with the help of special instruments.

The study of the obtained material is carried out in laboratory conditions. It can take several days.

The result shows the number of pathogenic microbes and beneficial bacteria.

Depending on the result obtained, a diagnosis is made.

Vaginal secretions are assigned one of four possible degrees of purity.

The first two degrees are considered good results. The third degree indicates the onset of the inflammatory process.

The last stage indicates the presence of a serious illness of an infectious or inflammatory nature.

Deciphering the result should be dealt with by the attending physician, only he is competent in making a diagnosis.

An increase in the number of leukocytes indicates an inflammatory disease. In this case, the amount of squamous epithelium will simultaneously increase.

The presence of mucus in the smear indicates the development of an infectious disease.

A healthy patient should be free of Trichomonas, fungal, key cells, and gonococci cells. Their presence speaks of a corresponding ailment.

The presence of key cells is a sign of vaginal dysbiosis.

Gonococci in a smear indicate infection with gonorrhea. The presence of fungi indicates the development of thrush. With trichomoniasis, Trichomonas will be found in the smear.

The number of leukocytes can reach 20 units. The rest of the smear must comply with the standards.

Often, candida fungi are present in the vaginal secretions of a pregnant woman. This indicates the development of thrush.

Various factors can affect the growth of fungi. These include excessive consumption of starchy foods, stress, weight gain, and pregnancy.

In medical practice, it is customary to regard the appearance of candidiasis as an indirect sign of successful conception.

Against thrush, drugs containing Clotrimazole are often prescribed.

It is customary to treat the inflammatory process with anti-inflammatory drugs. At the same time, it is recommended to use vitamin therapy.

To avoid disturbing the composition of microflora in the future, preventive measures should be followed. These include the following:

• use of PH-neutral products for intimate hygiene;
• balanced diet;
• douching should not be overused;
• having a permanent sexual partner;
• lack of stress;
• regular visits to the gynecological office.

The effectiveness of the diagnostic procedure will be much greater if you follow the rules for preparing for the analysis.

Sexual intercourse and taking antibiotics the day before are contraindicated. It is also not recommended to use medications in the form of suppositories and ointments.

If all the conditions are met, this study can be quite indicative. Otherwise, re-delivery of the biomaterial will be required.

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Questions

What are the standards for a vaginal smear for flora?

The results of a smear on flora are usually described on a special form on which the studied parameters are indicated (leukocytes, gonococci, Trichomonas, cocci, sticks, etc.). In addition, the form indicates the organs from which the smears were taken for analysis. Usually, the genitourinary organs on the test results form are designated by Russian or Latin letters - C (C), V (B) and U (U). C (C) means cervix (cervix), V (B) - vagina and U (U) - urethra (urethra). In the cells of the table, located at the intersection of the corresponding organ and the investigated parameter, the value of the latter is indicated. If the flora was examined from the urethra, from the vagina, from the cervix, then the table of the form indicates the results of all the studied parameters for each organ. However, the analysis results often indicate the values ​​of the studied parameters for only one organ. In such a situation, regardless of the cells in which the results of the studied parameters are recorded, they always refer to the flora of the vagina. The norms of various parameters of a smear on the flora for the vagina, urethra and cervix are shown in the table.

If the microflora of the vagina is represented not by rods or bacilli, but by cocci, then this may indicate bacterial vaginosis or inflammation.

Yeast fungi can normally be found in a smear in small quantities. However, usually the presence of fungi in the smear is not indicated if their number is small.

Mucus may normally be present in moderation or absent. The appearance of key cells is indicative of bacterial vaginosis. Normally, there should be no key cells in the smear.

E. coli can also be present in a smear in small amounts normally. However, this is usually not indicated in the smear results.

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Leukocytes in a smear in women: the norm, increased and the reasons for the deviation

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A gynecological, or urogenital, smear helps diagnose many diseases of the reproductive sphere. It determines the presence of pathogenic microbes, epithelial cells, blood cells and other indicators in the vagina.

A smear analysis for leukocytes is needed to identify not only infectious and inflammatory pathologies of the female genital organs, but also the severity of their course.

Indications for taking a smear

Leukocyte in a smear

A smear on the microflora is taken when examining a woman for the prevention and diagnosis of gynecological diseases. The indications for delivery are:

• pathological vaginal discharge;
• disruptions in the menstrual cycle;
• lower abdominal pain;
• itching, soreness, and burning in the vagina, urethra, and during urination;
• discomfort during intimacy;
• long-term use of antibiotics, hormones and other drugs;
• pregnancy, analysis is required in the first trimester

But even if there are no such symptoms, a smear should be taken every three months, since many pathologies are asymptomatic. Material for smear in women is taken from the walls of the vagina, urethra and cervix with a disposable spatula.

This is a quick, simple and painless procedure, and it brings pain and discomfort only with the affected walls of the urethra - when there is an infection or inflammation.

Preparing to take a smear

You should prepare for the procedure, since some factors lead to false test results - the detection of leukocytes in the absence of diseases, or vice versa.

Preparation for taking a smear is as follows:

1. Refusal of sexual intercourse 3 days before the visit to the doctor;
2. Stop taking drugs of any form (tablets, suppositories, douching, injections, ointments) a week before the study;
3. Within 2 days before the analysis, neither soap nor gel can be used for the hygiene of the external genital organs - only warm water, and the last intimate toilet is carried out the night before;
4. You must not urinate 3 hours before delivery.

A smear is not done during menstruation, except for urgent diagnosis. The best time for analysis is the first days after menstruation or shortly before their onset.

What do you look for when decoding an analysis?

In the interpretation of the results of the analysis, the degree of increase in leukocytes is important. The more of them, the more acute the infectious or inflammatory process proceeds.

For example, very high rates are detected with a recent infection with a venereal disease, in the case of an acute form of inflammation of the appendages, colpitis.

If leukocytes are increased in the smear, then attention is paid to other values ​​of this bacteriostatic analysis, since leukocytosis accompanies a change in the amount of other elements.

For example, with thrush there is the presence of fungal flora, with bacterial vaginosis and gonorrhea - coccal microorganisms, with inflammation of the vagina or endometritis, the number of Staphylococcus aureus bacteria increases. But the population of lactobacilli, which are normally present, and the acidity of the environment can be reduced.

Leukocytes in a smear are the norm in women, table

In the laboratory, when examining a smear under a microscope, the number of leukocytes in the field of view is counted, while the norm does not exceed 15. In a healthy girl or woman, a small amount of white blood cells is always present in the vagina.

When an infection appears, they recognize foreign cells and begin an active struggle - their number increases significantly.

In this table - the norm of leukocytes in a smear in women and other healthy indicators that are determined by the analysis.

Normally in gynecological smear also not found gardnerella, gonococcus, Trichomonas, chlamydia, atypical cells and yeast-like fungi (candida).

Test results are usually available within 2-3 days or on the same day.

If research has shown high content leukocytes, then the next task of the doctor is to identify the exact reason for their increase.

To do this, use PCR analysis (DNA diagnosis of the pathogen), bacteriological culture, take smears for latent infections and cytology (Pap test), if necessary, prescribe other diagnostic methods.

The cause of increased white blood cells in a smear in women

An infection or inflammation in the genitourinary organs is always accompanied by an increase in leukocytes in a woman's smear. The reason for the increase in their level may be hidden in various diseases:

• inflammation - appendages (adnexitis), uterine mucosa (endometritis), urethra (urethritis), cervical canal (cervicitis), vagina (colpitis);
• benign and malignant neoplastic formations of the genitourinary sphere;
• STDs - syphilis, trichomoniasis, gonorrhea, chlamydia, or others;
• dysbiosis - vagina or intestines;
• systemic diseases;
• hormonal imbalance.

A deviation from the norm in the analysis for leukocytes is associated with frequent stress, chronic overwork, prolonged use of antibiotics and other medications.

Sometimes an active sex life leads to a moderate increase in white blood cells in a smear - up to 25 cells.

Leukocytes during pregnancy

The norm of leukocytes in a smear in pregnant women is 15-20 cells in the field of view. During gestation, a woman's analysis is taken several times - the first at the most early dates when registering.

At the same time, a high level of leukocytes can speak of acute pathological process, and the presence of a latent infection, which worsened after the onset of pregnancy.

Most often these are inflammatory diseases caused by STDs, or thrush (candidiasis). After an accurate diagnosis, local treatment is prescribed, and if it does not give an effect, then, depending on the period, antibiotic therapy or other methods are chosen.

• Full transcript of a smear on flora, norms

The analysis of a smear for flora is one of the methods of examining women, which is used in gynecology. For research, a smear is taken from the mucous membrane of the vagina, urethra or cervix, which makes it possible to identify the presence of pathogenic flora, atypical cells in it, and also to assess the hormonal background of a woman.

The procedure for taking a smear is painless and is usually included in the doctor's list of actions when a patient visits him, and in the case of therapy, this analysis becomes necessary to ensure the effect of treatment.

How is the analysis done?

Before taking a smear, in 1-2 days it is necessary to comply with some conditions that are needed for greater information content and reliability of the results.

These conditions include:

• Do not have sex for 1-2 days before the test.
• Do not use cream, suppositories, vaginal tablets.
• Do not have a smear during your period.
• Do not douche and swim in the bathroom.

In addition, it is not recommended to wash the genitals with detergents, except for soap, on the day of visiting the gynecologist. It is not recommended to urinate several hours before taking a smear. The analysis from a woman is taken with a sterile (disposable) spatula from 3 places - the cervical canal of the cervix, the opening of the urethra and from the vaginal mucosa.

Flora smear: decoding

After taking a smear, the analysis is handed over to the laboratory, after which the doctor at the reception must decipher it to the patient. It is advisable to take smears for flora in the same medical institution, since the methods of staining and describing smears may differ in different laboratories.

You need to know that it is advisable to be examined by the same doctor, especially if you are receiving a course of therapy. For completeness of the study, a smear on flora will be taken before and after it, and can also be examined during the course of treatment. This is done to monitor the body's response to treatment.

It must be remembered that only an attending physician with a higher medical education can deal with the interpretation of the analysis. In order to avoid misunderstandings and false conclusions, it is not recommended to trust the interpretation of the analysis to other medical professionals.

What do these letters mean on the analysis form?

For brevity, doctors abbreviate the letters in which the values ​​of one of the analysis indicators are hidden. To understand what the normal flora of the vagina is, you first need to understand the meaning of the letters.

So, the letters and their meanings look like this:

• V, C and respectively U denote the places from which the smear is taken. V-vagina (vagina), C-cervix (cervical canal of the cervix), U-uretra (urethra). All the designations that stand opposite the letters indicate what was found at these points of research.
• L - means "leukocytes", which can be found in health and disease, but differ in quantity.
• Ep - means "epithelium", which in some cases is written as "Pl.Ep" or "squamous epithelium", which is more consistent with the name of the cells.
• Gn - stands for the causative agent of gonorrhea (gonococcus).
• Trich - means pathogen trichomoniasis (trichomonas).

In addition, the smear may contain mucus, the presence of which indicates the normal pH of the vagina, as well as Doderlein's sticks (lactobacilli), which normally constitute 95% of the total vaginal microflora.

In some laboratories, the amount of a particular flora is marked with a "+" sign, which is calculated in 4 categories - "+" - an insignificant amount, and up to "++++", which is characterized by an abundant amount. If there is no flora in the smear, then the laboratory marks it as "abs", which translated from Latin (abbreviated) means the absence of this type of flora.

What are Doderlein sticks?

At birth, the girl's ROP is neutral and the vagina is sterile. Gradually, various opportunistic microorganisms begin to penetrate into the vagina, but due to the neutral pH environment, they do not develop. Doderlein sticks appear in girls during the period of the formation of hormonal levels (12-14 years old), when the production of estrogen begins to prevail in the body.

The sticks feed on glycogen, which produces epithelial cells and protects the vagina from harmful and foreign bacteria. The breakdown product of glycogen is lactic acid, which creates an acidic environment in the vagina that can neutralize all pathogenic flora.

A reduced number of Doderlein sticks indicates an imbalance in the microflora and a shift in the pH in the vagina to the alkaline side, which is typical for women who are sexually active. The balance of microflora is actively influenced by both pathogenic microbes and opportunistic microbes, which can normally be found in the vagina.

What is coccal flora?

Cocci, which can also be found in the description of a smear, means the name of the flora, which is sometimes written as "coccal flora". According to the classification, all forms of bacteria are divided into spherical, rod-shaped and spiral-shaped. All spherical bacteria are called coccal flora.

These small bacteria can be found in normal conditions, as well as in various inflammatory diseases. With a decrease in immunity, the amount of coccal flora increases, and if it works well, single cocci can be found in a smear. In this case, cocci are positive, which are designated as gr +, and negative, which are written as gr-.

What is gr. + Or gr. - cocci?

According to another classification, all cocci are divided into gram-positive (Gr +) and gram-negative (Gr-). There is a method of staining smears according to Gram, after which all cocci were named. Gram-positive cocci include most of the pathogenic bacteria that remain stained after washing the smear.

These include, for example, staphylococci, enterococci, streptococci. Gram-negative cocci remain colorless, even after washing the smear with alcohol, and these include E. coli, gonococci, proteus. Lactobacilli (Doderlein's sticks) also belong to gram-positive bacteria.

What are the smear norms for flora?

Average smear rates are calculated for women under the age of 50 and for girls under 14 (who are sexually active). In little girls, the microflora of the smear differs in its composition, and at the age of more than 50 years, the hormonal background in women changes, as a result of which the norms of analysis also change.

Normal microflora at different points looks like this:

In addition, the smear should be free of other bacteria or fungi, for example, gonococci, chlamydia, yeast of the genus Candida.

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

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

The flora in a woman can change for a variety of reasons - with a decrease in immunity, taking antibiotics, with general infectious diseases and diabetes mellitus. One of these factors that can change the microflora is a change in hormonal levels. So, a pregnant woman practically does not produce estrogens until the end of pregnancy, but the hormone progesterone is produced in large quantities.

This hormonal background allows Doderlein's sticks 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 and identify the degree of cleanliness of the vagina before the planned pregnancy. 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 an incomplete list of diseases that weaken and loosen the walls of the vagina. This is dangerous because ruptures can occur during childbirth, which might not have been if the vagina was clean and healthy. Diseases such as mycoplasmosis, chlamydia and ureaplasmosis are not detected during smear analysis, and these pathogenic microorganisms can only be detected by analyzing blood by PCR (polymerase chain reaction), using special markers.

A smear analysis of a pregnant woman is taken during registration, and then for control 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.

What is vaginal cleanliness?

Purity specifications are as follows:

1. the degree of purity - the condition of a woman speaks of absolute health. In a smear, the microflora consists of 95% or more of lactobacilli, and single epithelial cells and leukocytes are also found.
2. degree of purity - the same picture as in degree 1, only a small amount of opportunistic bacteria can be found in a smear.
3. the degree of purity indicates that the number of opportunistic bacteria is greater than that of Doderlein sticks.
4. the degree of purity is a lot of epithelium, leukocytes (completely) and bacterial flora, and rods are found in small quantities or are absent.

As the degrees of cleanliness develop, so does the pH response of the vagina. At 1-2 degrees, it is acidic, and at 3-4 degrees it becomes slightly alkaline and alkaline.

What can a smear on flora tell about?

When a woman goes to a doctor, her complaints and examination carry a lot of information, but the analysis of a smear for flora is no less informative. The appearance of some elements in a smear can not only reveal possible diseases, but also make a prognosis and be the reason for an in-depth examination of a woman.

• Epithelial cells - an increase in their number indicates the presence of inflammation.
• Leukocytes - the presence of a small amount indicates a normocenosis, and a large number (completely in the field of view) indicates the presence of acute or chronic inflammation.
• Mucus - normally present only in the vagina, detection of mucus in the urethra indicates a possible inflammation of the urinary tract.
• Coccal flora - normally should not be in the urethra, and in the vagina - a small amount. An increase in the coccal flora leads to a decrease in the rod flora and a change in the degree of purity, which indicates vaginal dysbiosis and the presence of inflammation.
• Gonococcus - finding them in the vagina indicates the presence of gonorrhea.
• Trichomonas and gardnerella - speak of the presence of trichomoniasis and gardnerellosis.
• Yeast-like fungi - their detection in large quantities indicates a violation of the biocenosis and a change in the degree of purity. At the same time, the number of sticks decreases sharply, and doctors talk about the presence of candidiasis.

Thus, the analysis of a smear for flora is important indicator the work of the immune system, as well as the presence in a woman's body of dysbacteriosis and chronic infections. If necessary, the doctor can do a cytomorphological and bacterial examination of the secretions, which are special methods of analysis.