Tank sowing in men preparation. How do they take and decipher a smear for flora in men? Urine culture process

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Oleg asks:

How to decipher the results of a genital smear in men?

The following parameters are determined in a smear from the genital organs of men:

• Leukocytes;


• Epithelial cells;


• Slime;


• Microflora (what types of microorganisms are flora represented);


• The presence of gonococci, trichomonas, fungi of the genus Candida.

All of the above parameters are written on the smear results form. Opposite the parameters “leukocytes” and “epithelial cells” the doctor writes their average number in one field of view. The unit of measurement “N in the field of view” is inherent only in the microscopic examination of various smears (gynecological, from the throat, nose, etc.), since the doctor examines it in small parts that fall into the microscope eyepiece. The part that falls into the microscope eyepiece is called the field of view. That is, the doctor examines at least 10 fields of view in turn, moving the smear, and in each one counts the number of leukocytes and epithelial cells, after which he calculates the average value of these parameters, which he enters into the study results form.

Opposite the “mucus” parameter, the doctor can write the words “large amount”, “moderate amount”, “scanty amount” or indicate this with the following icons, respectively “+++”, “++”, “+”. If there is no mucus, then they usually write a “minus” sign or simply “no”.

Opposite the “microflora” parameter, the doctor writes what types of microbes the flora is represented by, for example, “cocci in small quantities” or “cocci and bacilli in large quantities,” etc.

Thus, knowing the value of each smear parameter, we can conclude whether there is an inflammatory process and what microbes it is caused by (its own microflora or pathogenic microbes).

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A smear from the urethra in men is taken to determine the presence of pathogenic microorganisms and their quantity in the urethra. It is thanks to the data of the study that it is possible to find out which microbes lead to the formation of infectious and inflammatory processes.

A considerable number of people who have not encountered this method of examination are interested in how material is collected from men, whether special preparation is needed, whether this process is accompanied by unpleasant and uncomfortable sensations, and what can be learned from its results. We will present information containing answers to these questions in this article.

What can a smear diagnose?

A smear from the urethra allows you to obtain information about the presence of inflammatory processes in the body, identify the pathogens that caused their appearance and assess the male microflora.

You can find out about:

• inflammation of the prostate gland, also called prostatitis in other words;
• an inflammatory process that is localized in the bladder - cystitis;
• inflammation of the urethra - urethritis.

In addition, a smear from the urethra shows infectious diseases of the genitourinary area, the route of transmission of which is considered to be sexual. The presence in the examined material can be diagnosed:

• mycoplasmas;
• chlamydia;
• fungi of the genus Candida;
• ureaplasma;
• Trichomonas.

When is the examination scheduled?

Scraping from the urethra is considered justified:

• if it is carried out for preventive purposes;
• in the case of infectious diseases, to determine the effectiveness of the treatment;
• in the presence of an inflammatory process of the genitourinary system;
• when pathological discharge appears, which has an unpleasant odor and has an irritating effect;
• in case of pain when performing the act of urination or during sexual relations.

Rules for preparing for a smear test

In order to obtain reliable and informative research results, special preparation is required, namely:

• Hygienic treatment of the genital organs should be carried out the day before the examination (in the evening). It is necessary to adhere to this recommendation because toileting the intimate area before visiting the laboratory may cause a distorted result. If the patient is accompanied by heavy discharge, it is allowed to carry out hygienic treatment of the genitals on the day of the test, but it should be carried out without the use of antiseptics and disinfectants.
• Two days before the day when biological material will be taken, you must abstain from sexual relations.
• Seven days before the day of the study, you must stop using any medications, especially antibacterial drugs.
• Two to three hours before collecting the material, it is prohibited to urinate.
• On the eve of the examination, you must stop drinking alcoholic beverages.

Material sampling technique

To take a smear from the urethra, you need to prepare a sterile instrument, namely:

• bacteriological loop;
• cotton swab;
• Volkmann spoon;
• urethral probe with tampon.

It should be noted that in some cases, when the material is taken, discomfort and pain may appear, despite the fact that the probe is not inserted very deeply (at a distance of 5 mm to 4 cm). Their appearance is explained by the fact that the male urethra is thin and has a high level of sensitivity. After insertion, the probe is rotated by performing rotational movements and removed from the urethra. After this, the resulting material is placed in a special pre-prepared test tube or applied to a sterile glass slide. The duration of the procedure does not exceed three minutes.

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Some of the material can be sent for PCR diagnostics, which helps to more accurately determine the type of infectious process and pathogen. And this, in turn, allows for correct and adequate treatment.

To obtain the results of a smear from the urethra, you need to wait several days, because microflora is cultured. Most often, the duration of this study does not exceed six days. It should be noted that if sexually transmitted diseases are detected, both sexual partners should undergo treatment, because only this can prevent re-infection in the future.

Please note that if there is an inflammatory process in the urethra, the examination may leave behind discomfort that lasts for some time. This is explained by the reaction of the inflamed mucous membrane of the urethra to a foreign body. If a man has no complaints and is healthy, then this procedure will be painless for him. All that may appear is a feeling of slight pain when urinating.

Interpretation of results

It is immediately necessary to emphasize that interpretation of the results should be carried out only by a qualified specialist, because this will allow for effective treatment that will help quickly eliminate the pathological process.

A smear from the urethra may contain:

• Leukocytes. A small number of them, up to five in the field of view, is considered a normal variant. If their number is greater, this may indicate the presence of an infectious process in the human genitourinary system or a tumor of the urethra or prostate gland. If the number of leukocytes exceeds a hundred, then this may be evidence that the man has trichomoniasis or gonorrhea. The exact cause of the increase in the number of leukocytes can only be determined by conducting additional examination methods, for example, PCR.
• Epithelial cells. They are exfoliated particles of mucous membranes. Their number of up to ten pieces is considered a variant of the norm, but if this number is greater, then this is evidence of a pathological process that is localized in the urethra. The amount of epithelium must be analyzed taking into account the number of leukocytes. Their equal number indicates the presence of an acute inflammatory process. If the number of epithelium is greater than the number of leukocytes, then this indicates the chronicity of the pathological process.
• Slime. Its presence in a smear in small quantities is not a pathology. If the indicator exceeds the norm, then this indicates the presence of microorganisms that are localized in the urinary tract. These could be: Trichomonas, coca, various fungi or chlamydia. In the case of a simultaneous increase in the amount of mucus, leukocytes and epithelial cells, it is necessary to suspect an infectious pathological process in the acute phase of the course. The chronic form of the disease will be indicated by the predominance of the amount of epithelium and mucus compared to protective cells.
• Opportunistic microorganisms. Normally, the flora of the urethra may contain streptococci and staphylococci. However, even a slight increase in their number is considered evidence of the formation of urethritis and other diseases.

A healthy man should not have gonococci in his smear; their presence indicates the presence of a disease such as gonorrhea. We can talk about trichomoniasis if trichomonas are detected. Thrush (fungal infection) is indicated by detection of a fungus.

How to take a smear from the urethra in men is one of the common questions from patients who are prescribed a laboratory test of a urogenital smear (scraping). As a rule, an analysis is necessary if the presence of sexually transmitted infectious diseases or some other pathologies is suspected.

According to reviews from patients who underwent this analysis, the sensations when taking the material are not very pleasant, but quite tolerable.

How is a urogenital smear taken?

Immediately before collecting the material, the penis is wiped with saline solution and dried with a sterile cloth, which prevents microorganisms from entering the sample from the surface of the skin. The material is collected using a special probe, which is inserted several centimeters into the urethra, then placed in a container with a transport medium specially designed for this purpose and delivered to the laboratory.

According to reviews from patients who underwent this analysis, the sensations when taking the material are not very pleasant, but quite tolerable. If there is an inflammatory process in the urethra, the patient experiences greater discomfort. After taking the material for research, you may experience discomfort when urinating for several days.

Typically, laboratory testing of a urogenital smear in men is completed within 1-3 working days.

Preparing for the study

To obtain an accurate research result, you should properly prepare for submitting the material. For three, or preferably seven days before the study, you should avoid physical overload and sexual contact.

If you are taking medications, especially anti-infective ones, you should warn your doctor about this, since in this case it may be advisable to postpone the analysis to a later date (usually 2-3 weeks after completion of treatment with antibacterial drugs).

The evening before the test, you need to thoroughly clean the external genitalia; in the morning on the day of collecting the material, you do not need to do this. You should not urinate for 2-4 hours before taking the test, so it is not recommended to drink a lot of liquid before the test.

If a patient is diagnosed with sexually transmitted infections, all sexual partners must undergo examination and treatment.

Indications for urogenital smear analysis in men

A urogenital smear is an accessible and informative method for diagnosing many diseases. Its analysis makes it possible to detect pathogens of sexually transmitted infections, inflammatory processes in the organs of the reproductive system (prostatitis, urethritis, etc.). The study may be needed as part of the diagnosis of infertility, during a preventive urological examination. In addition, a smear is prescribed after treatment to monitor its effectiveness.

Symptoms that may be suspicious of inflammatory urogenital diseases and require smear analysis are:

• pain during or after urination;
• frequent urge to urinate;
• discharge from the urethra;
• swelling and hyperemia of the genital organs;
• rashes in the genital area.

The results of a laboratory test of a urogenital smear should only be deciphered by a specialist. To diagnose most diseases, it is not enough to look at the smear result alone; a comprehensive assessment of the identified abnormalities, other diagnostic studies, as well as the clinical picture of the disease is required.

You can familiarize yourself in detail with the procedure for collecting material for research by looking at the corresponding photos and videos.

Types of urogenital smears

What the smear result shows depends on the type of test. Thus, a general urethral smear (flora smear) allows you to determine the number of leukocytes, erythrocytes, epithelial cells, microflora, etc. A urogenital smear for infections (another name is an analysis for hidden infections) makes it possible to detect sexually transmitted diseases, etc. .

To diagnose most diseases, it is not enough to look at the smear result alone; a comprehensive assessment of the identified abnormalities, other diagnostic studies, as well as the clinical picture of the disease is required.

If questionable results are obtained, a repeat study is prescribed; if the indicators are outside the normal range, additional diagnostics are indicated. For example, to clarify the presence of hidden infections, they resort to the polymerase chain reaction (PCR method), which makes it possible to identify the causative agent of the infection even in cases where the urogenital smear shows a negative result (for example, at the initial stage of the inflammatory process).

If a patient is diagnosed with sexually transmitted infections, all sexual partners must undergo examination and treatment.

Video from YouTube on the topic of the article:

When taking a scraping or smear from the urethra with a special brush or probe, biomaterial (mucus, discharge) is taken for subsequent examination under a microscope. If the material obtained from the patient is applied to a glass slide without changes, then such a preparation is called native.

It is sometimes mounted and stained, most often using a Gram stain or methylene blue. Staining facilitates microscopic visualization of gonococci, trichomonas, leukocytes, and epithelial cells.

However, urethral discharge is not always applied to glass. This method is not suitable for diagnosing STDs such as genital herpes, chlamydia, mycoplasmosis.

In this case, the material is added to a test tube, the tube is closed and delivered to the laboratory for PCR. In men with symptoms of diseases of the genitourinary organs, both types of studies are usually performed: PCR and conventional microscopy.

• Show all

  1. Indications for collecting material

  Indications for taking a scraping and urogenital smear from the urethra in men are:

  1. 1 Painful urination.
  2. 2 Increased frequency of urination.
  3. 3 The presence of mucous, mucopurulent or cheesy discharge (mucus, pus, serous effusion).
  4. 4 Redness, swelling of the tissue around the urethra and other symptoms of urethritis.
  5. 5 Rash on the glans and foreskin of the penis.
  6. 6 Swelling, redness and other signs of inflammation of the glans penis and foreskin (balanitis, balanoposthitis, posthitis).
  7. 7 Swelling and other signs of inflammation of the testicles and their appendages, seminal vesicles.
  8. 8 Enlarged inguinal lymph nodes.
  9. 9 Absence of symptoms in a man, but the presence of the above symptoms of an STD in a sexual partner. Often, men with STIs are asymptomatic, while women have pronounced symptoms.
  10. 10 Annual screening and medical examination for sexually transmitted infections is recommended for every young man who has more than 1 partner/year, even when using condoms.
  11. 11 Infertility in a couple, termination of pregnancy at any stage in a woman in a couple.
  12. 12 Preparing a woman for an upcoming pregnancy may also be an indication for diagnosing STDs in the expectant father.

  Often, sexually transmitted infections in men are asymptomatic, but lead to the development of the disease in women.

  The patient needs to understand that the accuracy of the result is influenced by many conditions: proper preparation of the patient for the study, the technique of collecting material and preparing a smear, the timing and conditions of transporting the material to the laboratory.

  2. Preparing for the test

  It is important to properly prepare for taking a smear:

  1. 1 During the day before the procedure, you should not shower, bath, or douche.
  2. 2 Cancel local antiseptics 48-72 hours before the study and all antibiotics at least two weeks before.
  3. 3 Avoid sexual intercourse and masturbation 48 hours before visiting the doctor.
  4. 4 The test must be taken two to three hours after the last urination. There is a small amendment here; for men with heavy discharge, it is enough to abstain from going to the toilet for 1 hour.
  5. 5 The most informative material is taken in the morning, before urination. Therefore, it is better for the patient to reduce the amount of fluid intake the night before.
  6. 6 What the direction for a general smear from the urethra looks like, see Figure 1.

  

  3. How is scraping taken from the urethra?

  The procedure for preparing the drug involves applying the discharge obtained from the surface of the urethral mucosa onto a glass slide. For a more detailed examination under a microscope, the smear can be stained with special dyes.

  1. 1 As a rule, the collection of material for a smear is carried out in a standing position, with underwear lowered.
  2. 2 Using a napkin, mucus is removed from the external opening of the urethra; a special brush and probe are inserted into the opening to scrape off the mucous membrane.
  3. 3 If there is no discharge, the patient is asked to massage the urethra from the base of the penis to the glans.
  4. 4 The brush is inserted 2 cm deep into the urethra. You should not perform rotating movements with the probe, as this manipulation is accompanied by severe pain.
  5. 5 The resulting material is applied to glass slides and labeled.
  6. 6 To identify motile trichomonas, a native preparation is prepared: saline solution (37°C) is added to the material applied to the glass slide. This method is applicable if a man has copious discharge from the urethra.
  7. 7 For subsequent microscopy in the laboratory, slides must be air dried and labeled. During a delayed study, the obtained biomaterial can be fixed on glass.

  Modern laboratories offer a comprehensive study of urethral discharge: microscopy of a simple smear in combination with bacterial culture and DNA determination of the most common pathogens of sexually transmitted infections using PCR.

  Pathogens
  Chlamydia trachomatis
  Mycoplasma hominis
  Mycoplasma genitalium
  Neisseria gonorrhoae
  Trichomonas vaginalis
  Gardnerella vaginalis
  Candida albicans

  Table 1. Pathogens determined by PCR using test systems

  4. Painful procedure

  Taking a smear separated for microscopy and PCR is accompanied by cutting pain in the area of ​​the urethra. After taking the material, the pain goes away within a few minutes. Cutting and burning in the urethra may appear at the beginning of urination for several hours after the procedure.

  Taking Canephron, Cyston, Phytolysin or urological preparations, drinking plenty of compotes and fruit drinks will help relieve unpleasant symptoms. It is better to give up spices, alcohol, and smoked foods for 2-3 days, then the metabolic products in the excreted urine will not greatly irritate the damaged urethral mucosa.

  5. Normal results

  It should be noted that the most correct interpretation of the results of a smear on the flora can be performed by a urologist.

  

  Table 2 - Normal indicators during smear microscopy for flora in men

  1. 1 Epithelium. Normally, a general smear reveals a small amount of epithelium of the urethra (flat, less often cylindrical, the number of epithelial cells is no more than 5-10 in the field of view). Detection of transitional epithelial cells is observed in prostatitis and inflammation of the prostatic part of the urethra. Exceeding normal values ​​is observed in acute and chronic inflammatory processes.
  2. 2 A leukocyte level of less than 4-5 in the field of view indicates the absence of an inflammatory process. An increase in the level of leukocytes indicates an inflammatory process in the urogenital tract and requires a more in-depth examination of the patient (PCR).
  3. 3 Slime. A large amount of mucus in the general smear (++ or +++) is observed during inflammation.
  4. 4 Microflora. Most of the microorganisms that enter the urethral mucosa are removed with urine flow. Organisms that were able to attach to the epithelium and multiply in environmental conditions are the microflora of the urethra. The development of the infectious process is accompanied by an inflammatory response and an increase in the number of leukocytes in the smear. In men, S. epidermidis, Streptococcus spp., Corynebacterium spp. can normally be detected on the urethral mucosa. in small quantities. Normal microflora is very sensitive to local and general changes in the body.
  5. 5 Trichomonas and gonococci should not normally be detected by microscopy. Their detection indicates trichomoniasis and gonorrhea.
  6. 6 Normally, a small number of extracellular diplococci can be detected; their type is clarified using PCR.
  7. 7 Fungi of the genus Candida should not be detected by microscopy.
  8. 8 Key cells and gardnerella are visualized in a general smear with gardnerellosis (baquaginosis).

  6. Urethritis

  The diagnosis of urethritis is confirmed when 4 or more leukocytes are detected in the field of view of the microscope.

  Microscopy of a smear from the urethra allows you to diagnose the inflammatory process in the urethra, assess the number and type of epithelial cells, and also identify pathogenic microorganisms (gonococci and trichomonas).

  If there are pathological changes and deviations from normal values, the man is prescribed additional laboratory diagnostic methods (usually PCR, less often culture).

  7. Urethral smear in the diagnosis of STIs

  7.1. Gonorrhea

  The causative agents of gonorrhea are Neisseria gonorrhoeae (Neisser's gonococci), bean-shaped cocci, located in pairs, with concave sides facing each other.

  Gonococci are detected when:

  • Microscopy of a stained specimen (Gram stain, methylene blue stain). The result can be positive (detected) or negative (not detected).
  • PCR. The PCR result can be positive or negative.
  • Bakposeve (sowing on chocolate agar). The method is used to make a diagnosis in children, regardless of microscopy results, when gram-negative diplococci are detected in a smear and there are no clinical manifestations.

  Gonococcal urethritis is confirmed by the following results:

  1. 1 Absence/decrease in the level of normal microflora.
  2. 2 Increased number of polymorphonuclear, not destroyed leukocytes (more than 4-5).
  3. 3 Identification of intracellular diplococci (located inside phagocytes).
  4. 4 Identification of extracellular diplococci.

  7.2. Trichomoniasis

  The causative agent is Trichomonas vaginalis, a protozoan. To detect trichomonas, it is necessary to examine freshly collected material from the urethra.

  To confirm trichomoniasis in men, the following are used:

  1. 1 Microscopy (method of “crushed” or “hanging” drop, staining of the preparation according to Leffler, Gram, Romanovsky-Giemsa). In the pathological material, living, mobile Trichomonas are determined (pear-shaped, oval shape, jerky, rotational movements of the microorganism).
  2. 2 PCR – diagnostics.
  3. 3 Cultural method (seeding on a nutrient medium). In men, due to the small number of trichomonas in the discharge, it is advisable to use the cultural method.

  7.3. Chlamydia

  Chlamydia trachomatis is difficult to see with a regular microscope, so the material obtained by scraping from the urethra is examined by PCR. The information content and reliability of such an analysis with proper preparation (see above) is very high.

  With chlamydia and chlamydial urethritis, the following results are possible:

  1. 1 When examining a simple smear through a microscope, an increase in the number of leukocytes is revealed (4 or more in the field of view).
  2. 2 The number of epithelial cells may be increased or within normal limits.
  3. 3 PCR revealed chlamydia trachomatis DNA.

  7.4. Genital herpes

  Testing for genital herpes is carried out in a specialized laboratory. Microscopy using conventional staining methods is not applicable due to low sensitivity and specificity. The main diagnostic methods are immunoluminescence (RIF), molecular genetic (PCR) methods.

  7.5. Human papillomavirus infection

  In laboratory diagnosis of HPV, exclusively molecular biological methods (PCR) are used. Microscopy of Papanicolaou-stained specimens is characterized by low sensitivity.

  Characteristic cytological signs of HPV: the presence of koilocytes (cells with heterogeneous hyperchromatic nuclei, a lighter rim of cytoplasm is determined perinuclearly), loss of nuclei. The described morphological changes in cells must be confirmed by molecular biological methods (PCR).

  8. Nonspecific urethritis

  If, according to the results of microscopy, an inflammatory process is observed in a man, but STI pathogens (gonococci, chlamydia, mycoplasma, ureaplasma, trichomonas, etc.) are not detected, then they speak of nonspecific urethritis.

  The development of this form of urethritis is based on facultative and anaerobic bacteria (staphylococci, streptococci, Enterobacteriae), gardnerella, and candida fungi.

  The diagnosis of nonspecific urethritis is a diagnosis of exclusion, which is made after negative results for sexually transmitted infections in both the patient and his female sexual partner.

  Microscopic criteria:

  1. 1 More than 4-5 leukocytes in the field of view of the microscope (magnification ×1000), in no less than 5 fields of view.
  2. 2 In chronic nonspecific urethritis, predominantly lymphocytes are detected in the flora smear.

  9. What to do after receiving the results?

  Often, patients with symptoms of STIs use the Runet as the main source of information and find paid laboratories where they can undergo examination without a doctor’s referral.

  1. 1 Consult your doctor based on your results!
  2. 2 Both sexual partners should be tested for sexually transmitted infections!
  3. 3 A negative result for one of the partners is not a reason to refuse examination of the other.
  4. 4 If the causative agent of infection is identified, the patient and his sexual partner should be prescribed antibacterial or antiviral therapy, depending on the type of pathogen. A month after the course of treatment, the collection of smears for flora and sexually transmitted infections is repeated for both partners. Pathogens Chlamydia trachomatis Mycoplasma hominis Mycoplasma genitalium Ureaplasma urealyticum, Ureaplasma parvum Neisseria gonorrhoae Trichomonas vaginalis Gardnerella vaginalis Candida albicans Human herpes virus types 1 and 2 Human papillomaviruses, highly oncogenic (16,18, etc.) and low-oncogenic (6,11, etc.)