Flora smear in women: what is determined by it, norm and pathology. Decoding the results of men

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

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

Why is this analysis prescribed?

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

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

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

• or vaginitis;

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

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

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

Advantages of the method:

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

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

Preparation for delivery

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

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

How is it surrendered?

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

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

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

The meaning of the letters on the analysis form

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

So, what are these letters:

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

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

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

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

What doctors don't see with microscopy?

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

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

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

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

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

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

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

Smear standards for flora

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

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

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

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

Table for deciphering the normal smear in women (flora)

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

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

Degrees of purity based on flora smear

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

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

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

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

What is coccal flora in a smear?

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

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

What are Doderlein sticks?

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

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

Flora smear during pregnancy

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

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

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

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

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

A smear on the flora is a simple and quite informative analysis that is taken by a doctor in women and men of any age both for the purposes of routine diagnosis, and in the case of acute or “erased” symptoms.

It allows you to assess the state of the microflora of the urogenital tract, determine the presence of certain inflammatory diseases, infections, viruses.

Some doctors say that this test does not require special preparation, however, this is not true. To ensure the reliability of the results, the patient is recommended do not 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 soap also contribute to unreliable indicators. Women It is necessary to take this test after the end of menstruation, and in addition, all patients should refrain from any sexual intercourse 2 days before taking the biomaterial.

How is the analysis performed?

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

The procedure for taking a smear is completely painless.

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

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

Research price

The results of a smear for flora are usually ready the next day, since the study is not specific and complex, so you can pick up your tests quickly enough. Flora smear is really considered a fairly simple test that can be done in a regular clinic for free. However, if deadlines are running out or you simply don’t trust the doctors from the clinic, then you don’t have to worry - a smear for flora can be taken at any paid medical laboratory.

Study price varies from 440 to 550 rubles and besides, you can pay separately for a medical worker to take biomaterial. The total will be approximately 900-1000 rubles.

Normal flora smear results in women

A flora smear examines indicators such as leukocytes, epithelium, microflora, infections (trichomoniasis, gonorrhea, candidiasis), mucus and key cells. Let's figure out what it means norm and pathology in this analysis and how to decipher it.

When you receive a form with the results, you usually see a table like this, where the following symbols are indicated at the top in Latin letters: "U", "V", "C", which literally means urethra (urethra), vagina and cervical canal. They are often written in full like this: "uretra", "vagina", "canalis cervicalis". Normally, the indicators of a smear analysis for flora in women should look like this:

Indicators	Urethra (normal)	Vagina (normal)	Cervical canal (normal)
Leukocytes	0-5 in p/z	0-10 in p/z	0-15-30 in p/z
Epithelium	Moderate or 5-10 in p/z	Moderate or 5-10 in p/z	Moderate or 5-10 in p/z
Slime	Moderate/absent	Moderately	Moderately
	Not found	Not found	Not found
Trichomonas	Not found	Not found	Not found
Yeast fungi (Candida)	Not found	Not found	Not found
Microflora	absent	sticks in large quantities or lactobacillary	absent
Key cells	none	none	none

Are you getting tested in a private clinic?

YesNo

Deviations from the norm of any indicators may indicate a pathological process or inflammation, but in order to prescribe treatment to the patient and make a diagnosis, the doctor needs to interpret the results of the study in their entirety. A slight excess or underestimation of indicators can be considered by the doctor as an individual norm, but this is permissible only if there are no patient complaints, and otherwise it is necessary to conduct additional tests or a repeat examination.

Decoding the results for women

For the urethra, vagina, and cervical canal, as mentioned above, there are normal indicators. For the urethra: leukocytes should be normal from 0 to 5 in the field of view, epithelium moderate or from 5 to 10 or 15 in the field of view, there should be no mucus, any infections (candidiasis, trichomoniasis, gonorrhea) and bacteria should not be normal.

Increasing performance leukocytes and epithelium in the urethra indicates an inflammatory process or urethritis, urolithiasis, mechanical damage to the urethra with a stone, sand or foreign object, which requires immediate consultation with a doctor. Revealing , Trichomonas and Candida fungi indicates specific urethritis. Increased slime in the analysis is possible due to violation of hygiene rules, improper collection of biomaterial.

For vagina: leukocytes fine must be from 0 to 10 in the field of view. However, during pregnancy leukocytes may increase, and therefore the permissible norm in this case will be from 0 to 20 leukocytes in the p/z.

This is not a pathology and does not require any special treatment.

The epithelium must be moderate or from 5 to 10 in sight, and mucus in moderate quantity. Infections (Trichomonas, Candida fungi,) normally absent, key cells too, and the microflora should be rod-shaped in large or moderate quantities. An increase in the number of leukocytes in a smear indicates an inflammatory process in the vagina, which occurs with the following diseases:

• colpitis;
• vaginitis,
• vulvoginitis (especially in girls under 14 years of age);
• urethritis;
• cervicitis (inflammation of the cervix);
• oophritis (inflammation of the ovaries);
• andexitis (inflammation of the uterine appendages);
• sexual infection.

Excess quantity squamous epithelium also a sign of an inflammatory process. A slight increase in levels is acceptable at a certain phase of the menstrual cycle, when the estrogen hormone begins to increase. Decline number of epithelial cells occurs in women during the period menopause, as the production of the hormone estrogen begins to sharply decrease.

Mucus in large quantities indirectly indicates an inflammatory process or non-compliance with hygiene rules. The vaginal microflora should be normal rod, which is represented by bifidobacteria and lactobacilli, which protect the body from infection and inflammatory diseases.

At pregnancy lactobacilli increase even more, since during such a period the body’s defenses are activated. A decrease in lactobacilli means vaginal dysbiosis (vaginal dysbiosis).

Mixed microflora is also quite common in smear results. It occurs in girls under the age of 14, as well as in women during menopause, which is considered as a normal variant. Otherwise, such flora may mean the following conditions:

• ovarian hyperfuction;
• inflammatory diseases of the pelvic organs;
• venereal diseases;
• vaginal dysbiosis;
• the beginning or end of menstruation.

Coccobacillary microflora indicates an imbalance of bacteria in the vaginal microflora, where pathogenic bacilli and cocci begin to predominate. The presence of such microflora indicates bacterial vaginosis or STI. Coccal flora often occurs with inflammatory diseases of the vagina, urethra, bacterial vaginosis (dysbacteriosis), etc. A common disorder of the vaginal microflora cannot be considered a diagnosis.

Key cells, or rather their presence in the smear indicate gardenellosis or vaginal dysbiosis. For the cervical canal: leukocytes should be normal from 0 to 15 or 30 in the field of view, epithelium moderate, A microflora, key cells, candida, trichomanas should be absent.

An increase in the number of leukocytes and epithelium indicates an inflammatory process of the pelvic organs, the presence of cancer, and sexually transmitted infections. Revealing candida mushrooms, trichomanas requires immediate treatment with antibiotics, since normally they should be absent.

Normal for men

In men, a smear of flora is taken to study the amount leukocytes, epithelium, presence of cocci, gonocci, trichomanas, mucus, microflora. Only the discharge is used for diagnosis from the urethra (urethra). The results of analyzes are also usually presented in the form of a table, where the indicators being studied are indicated in one column, and the results obtained in the other. In men, the norm of flora smear results is presented as follows:

Deviations from the norm are a serious reason to consult an andrologist or urologist, who will accurately diagnose and prescribe treatment. It should again be noted that it is necessary to take into account the laboratory reference values, which may be indicated nearby in the right column.

Decoding the results of men

The results of a smear for flora in men are normal the number of leukocytes should be from 0 to 5 in the field of view, epithelium from 5 to 10 in the field of view, cocci present in a single quantity, mucus in moderate quantities, and trichomanas, gonococci, and fungi are absent.

Deviations from the above norms indicate a pathological process or inflammation. Leukocytes- one of the main indicators that indicate to the doctor the degree of inflammation and pathology of the urogenital tract. They may be elevated in the following diseases:

• specific or nonspecific urethritis;
• prostatitis;
• urolithiasis disease;
• the presence of benign and malignant neoplasms;
• stricture (narrowing) of the urethra.

An increase in the epithelium also indicates an inflammatory process or urolithiasis, and the detection of cocci is approximately above 4-5 in the field of view means the presence of acute or chronic nonspecific urethritis caused by opportunistic bacteria. Slime in large quantities also indirectly indicates inflammation, but with normal other indicators it can indicate sluggish urethritis or prostatitis.

Presence in analysis gonococci, trichomands, Candida fungi indicates in favor of specific urethritis and, accordingly, diseases of gonorrhea, trichomoniasis, candidiasis. In any case, the doctor must take into account all the indicators of the smear for the purpose of further diagnosis and treatment.

Disadvantages of the analysis

In conclusion, it is worth noting that the main disadvantage of flora smear analysis is inability to detect sexually transmitted infections in a patient, but in any case, the doctor must evaluate your condition, symptoms and smear results.

A smear on the flora can be called a proven and simple way to study diseases of the urogenital tract, but not the only one and not fundamental when making a particular diagnosis.

Doctors often call this study “outdated”, “ineffective” and when seeing patients they immediately begin to take other, more modern tests, which in their opinion show the clinical picture in more detail. This is entirely the doctor’s decision and does not in any way detract from the specificity of the study. However, a standard flora smear in any case does not lose its relevance, and its diagnostic value is still quite high and in demand.

A mandatory procedure when visiting a gynecologist is to take biological material to assess the condition of the microflora and epithelial cells of the vagina, the internal mucous membrane of the uterine body, endometrium, and cervical canal.

A gynecological smear, the examination and interpretation of which is carried out in a laboratory setting, is highly informative.

The analysis allows us to determine the hormonal level of the reproductive system, the amount and composition of vaginal discharge, the bacterial content of microflora in women, prevent inflammatory processes, identify developmental pathologies, the presence of neoplasms and infections that are sexually transmitted.

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

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

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

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

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

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

The effectiveness and reliability of the method is 98%.

Preparing for a smear test

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

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

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

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

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

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

How to take a smear from women

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

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

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

Microflora smear: interpretation

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

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

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

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

Flora smear: normal in women

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

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

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

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

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

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

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

Smear for purity level

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

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

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

Bacteriological research

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

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

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

Cytological examination

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

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

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

PCR analysis

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

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

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

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

The most important diagnostic method in gynecology is a gynecological smear for flora. For the study, secretions from the urethra, vaginal mucosa and cervix are taken. It makes it possible to study the genitourinary system and assess its condition.

A smear on the flora is taken by a gynecologist every time a woman visits and during a preventive examination. Mandatory reasons for examination are complaints of pain in the lower abdomen, unpleasant itching and burning in the vagina, copious discharge, indicating the presence of an inflammatory process. When planning pregnancy, after a course of antibiotic therapy, it is also recommended to conduct this study.

How is a gynecological smear taken? More on this later.

Rules for taking a smear for flora

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

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

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

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

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

Gynecological and deviations from it

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

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

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

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

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

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

Deciphering a smear for flora

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

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

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

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

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

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

What is coccal flora in a smear?

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

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

Smear during pregnancy

How does the woman's research proceed?

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

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

Degrees of vaginal cleanliness

Gynecologists distinguish four degrees of vaginal cleanliness:

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

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

smear: deciphering the results

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

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

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

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

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

Depositphotos/lanakhvorostova

A smear on the flora is an integral procedure that is performed on a woman who has visited a gynecologist. This simple and accessible analysis allows you to detect many pathological conditions that sometimes do not manifest themselves clinically. Such diseases include thrush, bacterial vaginosis, colpitis, STIs and others.

Indications

A smear on the flora in women is performed in the following cases:

• Unpleasant sensation in the area of ​​the vaginal vestibule: itching or burning;
• Pain or cramping in the lower abdomen;
• As a preventative measure;
• When planning pregnancy;
• Against the background of long-term antibiotic therapy.

Preparation

You can take a smear for microflora regardless of the day of the menstrual cycle. The exception is the days of immediate menstruation. The fact is that monthly bleeding affects the performance of the analysis and can lead to false positive or false negative results. The best days to take a smear are the days preceding the onset of a new menstrual cycle or immediately after the critical days.

• Douching;
• Suppositories;
• Kremov;
• Tablets;
• Lubricants.

Direct preparation for the manipulation of taking a smear for microflora in the fair sex consists of hygienic treatment of the external genitalia, which is carried out the previous evening. Intimate hygiene involves washing using warm running water without soap.

Analysis of the results obtained

When receiving the results of a smear, the following inclusions may be detected in it:

• Leukocytes;
• The epithelium is flat;
• Slime;
• Lactobacilli;
• Yeasts and yeast-like fungi;
• "key cells";
• Trichomonas;
• Gonococci;
• Escherichia coli;
• Strepto-, staphylo-, enetorococci.

Some of them are normal and constitute the biocenosis in the vagina of an absolutely healthy woman. The presence of certain bacteria, as well as an increased content of opportunistic bacteria, indicates the presence of a particular pathological process.
Correct interpretation of a smear for microflora in women is very important at the stage of preliminary diagnosis of the disease.

So, a smear for microflora can have the following letter designations and abbreviations:

• “V” is an abbreviation for vagina, or vagina. Everything that is indicated opposite this column refers to the flora that is in the vagina.
• "C" is an abbreviation for the cervix, or cervix. Accordingly, it reflects the result of the microflora in the cervical canal.
• “U” is the letter designation for the urethra, or urethra. The values ​​next to this letter will be understood by the doctor as indicators of flora in the urethra.
• “L” - flora smear reflects the number of leukocytes.
• "Ep" - squamous epithelium.
• "abs" is a Latin designation that should be interpreted as the absence of something. “gn” is a designation for gonococci, the microorganisms that cause gonorrhea.
• "trich" is the abbreviated name for another pathological bacterium, Trichomonas, which causes trichomoniasis.

A smear test for flora in women is the norm; a table that clearly demonstrates the results of the analysis:

Index		Norm
	V	U	C
Leukocytes (L)	0-10	0-5	0-30
Squamous epithelium (ep.)	Up to 5-10 in sight	Up to 5-10 in sight	Up to 5-10 in sight
Slime	moderately	Moderate/absent	moderately
Yeast, yeast-like fungi, Candida fungi	none	none	none
Gonococci	none	none	none
Key cells	none	none	none
Trichomonas	none	none	none
Tlamydia	none	none	none

Deviations of vaginal smear indicators from the norm

Deviation of results from the norm depending on the indicator should be interpreted as follows:

1. If the number of leukocytes increases, the presence of an inflammatory process should be suspected. Normally, the state of leukocytosis can only be observed in pregnant women. Their indicator can increase to 20-30 in the field of view.
2. The squamous epithelium in a smear in women can deviate from normal values, both increasing and decreasing. Its complete absence indicates atrophic processes in the uterus, which usually occurs with a lack of the hormone estrogen. An increased amount, in turn, indicates inflammation in a woman’s body.
3. Mucus is normally produced only in the vagina and cervical canal. Excessive mucus secretion is another sign of inflammation.
4. Lactobacilli in a smear in women and other gram-positive bacilli, when reduced, increase the risk of inflammation due to a low immune response.
5. The presence of pathogenic microorganisms (Trichomonas, gonococci and chlamydia) are an indicator of the presence of diseases such as trichomoniasis, gonorrhea and chlamydia, respectively.
6. The appearance of key cells is characteristic of a pathology such as bacterial vaginosis.
7. A smear on the flora in women, containing yeast, fungi of the genus Candida, indicates the presence of thrush.
8. An increased content of opportunistic cocci in a smear is an indicator of infection in the woman’s genital organs.
9. The appearance of Escherichia coli (E.Coli) in the smear means that the flora of the end of the intestine (rectum) has entered the vagina. This could happen due to improper hygiene, wearing thongs. E. coli found in a smear in women accompanies the development of bacterial vaginosis.

Degrees of vaginal cleanliness

So, the degree of vaginal cleanliness can be one of 4 degrees, depending on the results shown by a smear on the flora.

• I degree of purity - characterized by a normal level of leukocytes, a moderate amount of mucus and squamous epithelium in the smear. Pathogenic and opportunistic flora are absent. The vaginal microflora is mainly represented by various types of lactobacilli. The first degree of vaginal cleanliness is ideal; it symbolizes the correct microflora and a woman’s strong immunity. It is quite rare.
• 2nd degree of purity - the level of leukocytes is still within normal limits, and mucus and epithelium are contained in moderate quantities. However, the vaginal flora consists not only of lactobacilli, but also of cocci or yeast fungi. This degree of purity of the gynecological smear indicates a decrease in local protection and an increased risk of the inflammatory process. Refers to the normal variant. The most common variant observed in women.
• 3rd degree of purity - characterized by an increase in the number of white blood cells (leukocytes), which indicates the presence of an inflammatory process in the woman’s body. The composition of the microflora is mainly represented by pathogenic bacteria: yeast, cocci. Lactobacilli are found in small quantities in women's smears. If there is a 3rd degree of purity, the woman is required to undergo treatment.
• 4th degree of purity - leukocytes significantly exceed the norm and sometimes cover all fields of vision, beyond counting. There are no lactobacilli in the smear, and the vaginal flora is represented by pathogenic microbes. Squamous epithelium in the smear and drainage are detected in large quantities. This degree of purity is a signal for the emergency start of anti-inflammatory therapy.

Thus, a smear on the flora is an important analysis to help the gynecologist to make a preliminary diagnosis and identify the inflammatory process in the gynecological area in a woman. After this analysis, additional ones may be required, such as culture of flora and determination of sensitivity to antibacterial drugs, which together will help the doctor prescribe adequate treatment.