It is necessary to visit a gynecologist every six months. This will keep women's health under control and timely identify diseases. The simplest and most affordable research method in gynecology is taking a gynecological smear.
Deciphering such an analysis will allow the doctor to see changes in the female reproductive system that are not visible during an external examination.
Deciphering the analysis of the smear on the flora can tell the gynecologist about the presence of genital infections, inflammation, hormonal disorders in the woman's body.
A smear on the flora (gynecological smear) is mandatory if a woman complains of the following nature:
Smears are also taken during preventive examinations.
With the help of letters, the doctor marks the place where the smear is taken. The letters of the Latin alphabet are usually used: V, C, U.
Swabs are taken from three points: the vagina (V-vagina), the cervix (C-cervix) and the urethra (U-uretra).
In deciphering a smear on the flora in women, you can find the strange word "cocci". Cocci are microorganisms that have a rounded shape. This is a group of conditionally pathogenic organisms that are constantly present in the body.
However, they must be in a certain amount. As soon as their number exceeds the permissible, cocci can cause unpleasant symptoms due to inflammation. In gynecology, this condition is called nonspecific colpitis.
Cocci are divided into two groups: Gram-positive and Gram-negative. This division has an important diagnostic value in determining the pathogenicity of a microorganism that has settled in the vagina.
smear on the flora of cocci bacillus
The division of microbes into gram-negative and gram-positive appeared in microbiology after a Danish scientist named Gram revealed the ability of microorganisms to stain in different colors, depending on the degree of their resistance to antibiotics.
When staining the preparations, a special dye of dark blue or violet color was used. The scientist noticed that some microbes are colored blue, while others are pink, although the dye is the same.
After careful research, it was found that pink or crimson-colored microbes are less sensitive to antibiotics. In order for them to die, considerable efforts should be made.
Microorganisms that stained well in blue were called gram-positive (gram +), and those that remained pink - gram-negative (gram-).
The pale coloration and resistance to antibacterial drugs was explained simply: these bacteria had a thicker shell. The structure of the wall has a more complex structure than that of gram (+) cocci, which means that it is much more difficult for a dye or an antibiotic to penetrate into its layers.
For a gynecologist, this separation is important. Detection of gram (+) cocci in a smear is allowed. These microorganisms include staphylococcus and streptococcus, which may be present in the vagina of a healthy woman.
Gram(-) cocci can cause disease. The most common representatives of this group in gynecology are gonococci, the causative agents of gonorrhea.
An obligatory element of women's health is the rod flora in the vagina. Dederlein sticks is a generalized name that combines large and immobile gram-positive rods that provide the normal microflora of the female genital organs.
They can be found under the name lactobacilli or gram-positive rods.
Dederlein sticks play an important role in a woman's life:
In a smear of a healthy woman, Dederlein sticks should be in large quantities. A decrease in their number indicates possible problems with women's health.
Leptotrix is an opportunistic pathogen. It is a gram (+) anaerobic bacillus that inhabits water bodies. Under the microscope, leptothrix looks like a hair - a long and thin stick.
It is believed that leptotrixes are not sexually transmitted, and their presence in a smear is not a cause for concern if no other abnormalities are found.
A feature of these bacteria is that they often accompany other pathogenic microorganisms - Trichomonas and Chlamydia. In this case, the doctor will prescribe medications to treat several pathogens at once.
If leptotrixes are detected during pregnancy planning, treatment is mandatory. It was revealed that they can cause miscarriages, cause inflammation in the membranes, and infect the child.
smear analysis
After receiving the results of the tests, 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 norm indicators when deciphering the smear analysis for flora. There are few of them.
In the analysis of a smear in an adult woman, the normal indicators are as follows:
The presence in the results of the analysis of fungi of the genus Candida, small rods, gram (-) cocci, Trichomonas, gonococci and other microorganisms indicates the presence of the disease and requires a deeper study and treatment.
| Indicator | Values of normal indicators | ||
| 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 + sticks (Dederlein sticks) | No | No |
Often the doctor writes out a referral for a smear analysis for purity. With this method, the "degree of purity" of the vagina is revealed. There are four in total. Only the first and second degrees are normal, the third and fourth degrees signal the presence of diseases of the genital tract.
1 degree - an ideal option, which, unfortunately, is rare. Leukocytes in the smear do not exceed the permissible limits. The flora is represented by a large number of Dederlein sticks, mucus and desquamated epithelial cells in a small amount.
2 degree - The most common variant of the norm, in which leukocytes are within the normal range, mucus and epithelium are in moderate amounts. A small amount of cocci or Candida fungi appears, lactobacilli in large quantities.
3 degree - a large amount of mucus and epithelial cells is determined in the smear. There are few useful lactobacilli, instead there is an increased number of Candida fungi and pathogenic microbes.
4 degree - there are so many leukocytes that the doctor describes them with the term "completely." A very large number of pathogens. Dederlein's sticks are absent. Mucus and epithelium in large quantities.
The first and second degrees do not require treatment, and the last two degrees indicate an inflammatory process caused by a particular pathogen and require urgent therapy.
For the entire period of pregnancy, it is done three times, during screening examinations: at the time of registration, at the 30th week and before the expected date of birth.
The analysis is carried out in order to prevent diseases of the genital area, which can complicate childbirth or cause diseases in the newborn.
The indicators of a smear of a pregnant woman differ from those of a non-pregnant woman in the quantitative composition of the flora.
During the period of bearing a baby, the number of Dederlein sticks increases tenfold. This is necessary to maintain an acidic environment, which has a deadly effect on pathogenic microbes, protecting the fetus from infection.
The number of epithelial cells also increases. During pregnancy, they accumulate glycogen stores, which are used by lactobacilli as food.
Otherwise, there are no differences. The appearance of pathogenic microorganisms also requires treatment, only the methods of therapy are chosen more sparing (suppositories, tampons, ointments).
smear on flora- an analysis often prescribed by gynecologists. What does it show and what misconceptions exist about it?
This analysis can be called "general". This is the primary diagnosis, which allows the doctor to confirm or deny the presence of an inflammatory process in the vagina, urethra, cervical canal, as well as draw certain conclusions regarding the possible menopause or menopausal changes in the patient.
What is the name of the analysis:
Used to diagnose infectious and inflammatory processes. Bacterioscopy allows you to detect bacteria in the genitals of a woman: the simplest microorganisms - gonococci, which provoke gonorrhea, Trichomonas - the causative agent of trichomoniasis. Also, a specialist in a microscope will see some bacteria, fungi (Candida), key cells (a sign of bacterial vaginosis). The type of microorganism is determined by the shape, size, and whether it is stained with a dye or not, that is, it is gram-positive or gram-negative.
In addition, in a smear from each point (taken from the vagina, urethra, cervical canal), the number of leukocytes in the field of view is counted. The more of them, the more pronounced the inflammatory process. The amount of epithelium and mucus is estimated. especially a lot in women of reproductive age during ovulation - in the middle of the menstrual cycle.
Microscopic examination of the discharge of female genital organs is an opportunity to quickly assess whether a woman is gynecologically healthy or not and make one of four diagnoses:
If there are no clear signs of one of these diseases, but the smear is bad, an in-depth study of the material is carried out - bacteriological culture is performed.
Some types of fungi, such as Candida albicans (Candida albicans - a diploid fungus), are very dangerous for expectant mothers and can provoke infection and premature rupture of the membranes.
Other types of Candida fungi can be left untreated if there are no pathological symptoms.
If key cells are found (signs of bacterial vaginosis), but other microbes are present in addition to them. For identification.
in the research method. With a general smear, the material applied to the glass is stained with special dyes and viewed under a microscope. And when they do a bacteriological (bacteriological, cultural, microbiological) study, then it is first “sown” on a nutrient medium. And then, after a few days, they look under a microscope - colonies of which microorganisms have grown.
That is, if we are talking about express analysis, you will be given a conclusion only on the number of leukocytes, epithelium and mucus. Sowing is not urgent
Also, with microscopy, you can quickly determine the degree of purity from the vagina. Here the doctor only evaluates the ratio between normal, opportunistic and pathogenic microflora.
The classic assessment of vaginal cleanliness.
Updated table
| Degrees | signs |
| I | Dederlein sticks, squamous epithelium. |
| II | Non-pyogenic bacteria. Leukocytes are normal. Diagnosis: non-purulent bacterial colpitis. |
| III | Pyogenic (staphylococci, streptococci, Pseudomonas aeruginosa, gonococci, etc.) microorganisms. High level of leukocytes. Purulent bacterial colpitis. |
| IV | Gonorrhea (gonococcus found). |
| V | Trichomoniasis (trichomonas detected). |
| VI | Vaginal candidiasis (mushrooms found). |
CC and other pathologies (erosion, leukoplakia, atypical cells, etc.) are determined according to 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.
The first four infections are diagnosed by PCR. And it is impossible to determine the presence of the immunodeficiency virus by a smear with high accuracy. You need to take a blood test.
The doctor takes a smear from the patient on the gynecological chair (regardless of whether she is pregnant or not) using a special brush or a sterile Volkmann spoon. It doesn't hurt at all and is very fast.
It is technically possible to achieve a good, even perfect smear, if you sanitize the vagina with chlorhexidine or miramistin, for example. But what's the point?
To get a reliable smear result, 48 hours before it is taken, you cannot:
Pap smears should be taken outside of menstrual bleeding. Even if there is just a "daub" on the last day of menstruation, it is better to postpone the study, since the result will certainly be bad - a large number of leukocytes will be revealed.
There are no restrictions on drinking alcohol.
Can I take a smear while taking antibiotics or immediately after treatment? It is undesirable to do this within 10 days after using topical drugs (vaginal) and one month after taking antibacterial agents inside.
Microscopic examination is prescribed:
To begin with, we bring to your attention a table that displays the indicators of the so-called first degree of purity. There is no mention of the urethra in it (although the material is also taken from there), since we are talking about gynecological diseases. The inflammatory process in the urethra is treated by a urologist.
| Indicator | Vagina | cervical canal |
| Leukocytes | 0-10 in sight | 0-30 in sight |
| Epithelium | depending on the phase. cycle | |
| Slime | moderately | |
| Trichomonas | No | |
| Gonococci | No | |
| key cells | No | |
| candida | No | |
| Microflora |
gram-positive rods |
is absent |
Epithelium - the number of epithelial cells is not counted, as it has no diagnostic value. But too little epithelium indicates an atrophic type of smear - it happens in women during menopause.
Leukocytes - are considered in the "field of view":
Mucus (strands of mucus)- normally should be present, but a large amount of it happens with inflammation. There should be no mucus in the urethra.
Rod flora or gr lactomorphotypes- the norm, this is the protection of the vagina from microbes.
Trichomonas, gonococci and key cells a healthy woman should not have it in the cervix and vagina. Candida is also normally absent. At least in a significant amount, which is detected in the analysis of the flora.
The validity of the smear is not great. But if a woman enters a hospital, then right there, during the initial examination on the chair, they take a fresh one.
Usually the results are valid for 7-14 days. Therefore, if you need to take it before the operation, do it 3 days before admission to the hospital. The last of the scheduled tests.
A gynecologist can best decipher the result of a cultural study. But you yourself, if you read the information below, will roughly understand your analysis.
The number of microorganisms can be expressed in "crosses":
But more often the number of representatives of the microflora is expressed in degrees. For example: Klebsiella: 10 to the 4th power. By the way, this is one of the representatives of enterobacteria. Gram-negative bacillus, aerobic microorganism. One of the most dangerous pathogens, although it is only conditionally pathogenic. This is because Klebsiella is resistant (immune) to most antibacterial agents.
Below we describe other common terms that appear in the results of the study, or you may hear from a doctor.
Soor is candidiasis or, in other words, thrush. It is treated with antimycotic (antifungal) drugs.
Blastospores and pseudomycelium of yeast-like fungi- candidiasis or other fungal disease, usually treated similarly to thrush.
Diphtheroids are conditionally pathogenic microorganisms, according to the results of research by scientists, in most women, about 10% of the microflora is made up of them, as well as streptococci, staphylococci, E. coli, gardnerella. If the flora is disturbed, their number increases.
Mixed flora - a variant of the norm, if there are no symptoms of the disease, completely leukocytes or their strong increase (40-60-100). 15-20 is a variant of the norm, especially during pregnancy.
Enterococci (Enterococcus)- representatives of the intestinal microflora, which sometimes enter the vagina. Gram-positive cocci. About Enterococcus fecalis (Enterococcus faecalis) we. There is also enterococcus coli - Escherichia coli. Usually cause unpleasant symptoms at concentrations above 10 to the 4th degree.
Pseudomonas aeruginosa is a Gram-negative bacterium. Often affects people with low immunity. It has good resistance to antibiotics, which makes the treatment process difficult.
polymorphic bacillus- a common representative of the vaginal biocenosis. If the number of leukocytes is normal and there are no complaints, its presence should not disturb.
Erythrocytes - there may be a small amount in a smear, especially if it was taken during an inflammatory process or when there was a small spotting.
Coccal or coccobacillary flora- usually occurs with an infectious process in the vagina or on the cervix. If a woman has complaints, antibacterial treatment is required - sanitation of the vagina.
Diplococci are a type of bacteria (cocci). Small amounts are not harmful. With the exception of gonococci - the causative agents of gonorrhea. She is always treated.
And in conclusion, we give frequent abbreviations that are written on the forms of test results:
Laboratory diagnostic methods in obstetrics and gynecology are an important component of assessing the health status of the female body.
Among their diversity, a simple smear on the flora has stood apart for many decades.
Its other names are: smear on the degree of purity, smear on GN, gynecological smear, bacterioscopy of the discharge of the genitourinary organs, microscopy of the discharge from the urethra, vagina and cervix.
This study allows you to evaluate the composition of the microflora, count the number of leukocytes and epithelial cells, and also diagnose some STDs (gonorrhea, trichomoniasis).
This is a routine, non-invasive, economical and quite informative method, widely used in the work of a gynecologist.
Based on its results, the doctor has the opportunity to determine further tactics for managing the patient and prescribe the appropriate treatment.
When is the analysis performed?
As a rule, a smear on the flora is taken at any initial visit of a woman to a gynecologist.
Also indications for taking a smear and its subsequent microscopy are:
Taking a gynecological smear is possible from three points: the urethra (if necessary), the posterolateral fornix of the vagina and the vaginal part of the cervix.
The material for analysis is vaginal discharge, discharge from the cervical canal, discharge from the urethra (according to indications).
Vaginal secretions are multicomponent, they include:
Before taking the material, a woman must meet certain conditions:
Recently, special attention has been paid to the normal composition of the vaginal microflora, since it has been proven that it is this factor that determines the reproductive health of a woman, provides local immunity, protection against pathogenic bacteria, and the normal onset and course of pregnancy.
Normally, 95% of the flora in a woman is lactic acid bacteria (otherwise Doderlein sticks, lactobacilli, lactobacilli).
In the course of their vital activity, lactobacilli process glycogen released from epithelial cells, with the formation of lactic acid. It is she who provides the acidic environment of the vaginal contents, which prevents the reproduction of facultative and pathogenic flora.
Every woman has 1-4 types of lactobacilli in her vagina, and their combination is purely individual.
When deciphering the results of the analysis, it is impossible to conduct a detailed analysis of the vaginal microflora, the laboratory assistant evaluates only the ratio of rods and cocci.
The absence of cocci and a large number of gram-positive rod flora (++++) equate to 1 degree of purity of the vagina. This is observed quite rarely, this situation is more typical for control smears after vaginal sanitation or antibiotics.
A small amount of cocci (+, ++) is considered normal and indicates a 2nd degree of purity, but only if rod flora (++, +++) is also found. This is a good smear.
It is considered pathological (+++, ++++) against the background of a decrease in the number of rods (+, ++). This result is called the 3rd degree of purity of the vagina. This situation requires a detailed examination.
A large number of cocci (++++) and the complete absence of gram-positive rods (Gram + rods) in the smear indicate 4 degrees of purity. In this case, the woman needs mandatory treatment.
Table 1 - Normal indicators evaluated when deciphering the results of smear microscopy for flora and GN. Click on the table to view
- single-celled microorganisms of a rounded shape. The vaginal environment is ideal for their growth and development due to the high content of glycogen.
But due to the competing lactobacilli flora, with a normal level of immunity, their active growth is not observed. For the acquisition of pathogenic properties by fungi of the genus Candida, certain conditions are necessary:
Should not be found. In exceptional cases, their single detection is allowed in the material taken from the posterolateral fornix of the vagina, as an integral part of the facultative flora. It is important to take into account the presence / absence of complaints and clinical manifestations.
The detection of spores and mycelium of the fungus in a smear indicates vaginal candidiasis and requires appropriate specific treatment.
Although it is a fairly informative diagnostic method, it is relevant only when comparing the result of microscopy with complaints and clinical manifestations.
The main disadvantage of this research method is the impossibility of identifying a specific pathogen. According to the results of the smear analysis, it is impossible to assess the level and depth of tissue damage.
Therefore, when an inflammatory process is detected in a smear, the doctor may prescribe additional diagnostic methods aimed at identifying the pathogen (PCR, bacteriological examination of the discharge of the urinary organs and determining sensitivity to antibiotics).
Smear analysis for flora is one of the methods for examining women, which is used in gynecology. For research, a smear is taken from the mucous membrane of the vagina, urethra or cervix, which allows you 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 verify the effect of the treatment.
Before taking a smear, for 1-2 days it is necessary to observe some conditions that are necessary for greater information content and reliability of the results.
These conditions include:
In addition, it is not recommended to wash the genitals with detergents other than soap on the day of visiting the gynecologist. A few hours before taking a smear, it is not recommended to urinate. The analysis of 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 mucous membrane of the vagina.
After taking a smear, the analysis is submitted 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 different laboratories may have different staining methods and descriptions of smears.
You need to know that it is desirable to be examined by the same doctor, especially if you are receiving therapy. For completeness of the study, a smear for 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 therapeutic measures.
It must be remembered that only the 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.
For brevity, physicians abbreviate the letters in which the value of one of the analysis indicators is 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:
In addition, the smear may contain mucus, the presence of which indicates the normal pH of the vagina, as well as Doderlein sticks (lactobacilli), which normally make up 95% of the entire vaginal microflora.
In some laboratories, the amount of a particular flora is marked with a "+" sign, which is calculated according to 4 categories - "+" - an insignificant amount, and up to "++++", which characterizes an abundant amount. If there is no flora in the smear, then the laboratory marks it as “abs”, which in Latin (abbreviated) means the absence of this type of flora.
At birth, a girl's pH is neutral and her vagina is sterile. Gradually, various conditionally pathogenic 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 formation of the hormonal background (12-14 years), when the production of estrogens begins to predominate in the body.
The sticks feed on glycogen, which is produced by epithelial cells, and protect 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 pH shift in the vagina to the alkaline side, which is typical for women who have an active sex life. The balance of microflora is actively influenced by both pathogenic microbes and opportunistic microbes, which can normally be found in the vagina.
Cocci, which can also be found in the description of a smear, mean 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 occur normally, as well as in various inflammatory diseases. With a decrease in immunity, the amount of coccal flora increases, and with its good work, single cocci can be detected in a smear. In this case, cocci are positive, which are designated as gr +, and negative, which are written as gr-.
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 Escherichia coli, gonococci, Proteus. Gram-positive bacteria also include lactobacilli (Doderlein sticks).
Average smear rates are calculated for women under the age of 50 and for girls under 14 (able to be sexually active). In little girls, the microflora of the smear differs in its composition, and also at the age of more than 50 years, the hormonal background in women changes, as a result of which the analysis standards also change.
Normal microflora at different points is as follows:
|
Indicator |
Vagina |
Cervix |
|
|
Leukocytes |
3-5 in sight |
5-10 in sight |
0-5 in sight |
|
squamous epithelium |
In moderation |
In moderation |
In moderation |
|
In moderation |
In moderation |
Moderate or absent |
|
|
Gram-positive rods (gr+), Doderlein rods, |
In great numbers |
missing |
missing |
|
Gram-negative rods (gr-) |
missing |
missing |
missing |
In addition, the smear should be free of other bacteria or fungi, such as gonococci, chlamydia, yeast fungi of the genus Candida.
The microflora of each woman is strictly individual, and normally consists of 95% of lactobacilli that produce lactic acid and maintain a constant pH of the internal environment. But in the vagina there is also a conditionally pathogenic flora. 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 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 a woman (inflammatory process).
A woman's flora can change for a variety of reasons - with a decrease in immunity, taking antibiotics, with common infectious diseases and diabetes. One such factor that can change the microflora is a change in hormonal levels. So, in a pregnant woman, until the end of pregnancy, estrogens are practically not produced, 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 before the planned pregnancy and determine the degree of purity 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, bacterial vaginosis, gonorrhea, trichomoniasis - this is a far from complete 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 happened if the vagina were 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 a blood test by PCR (polymerase chain reaction), using special markers.
A smear analysis from a pregnant woman is taken at the time of registration, and then for control at 30 and 38 weeks. Usually, to assess the state of the microflora of the vagina, doctors talk about the so-called degrees of purity of the vagina, which a woman must know and ensure that the necessary degree is maintained during pregnancy.
The characteristics of the degrees of purity are as follows:
As purity levels develop, so does the vaginal pH response. At 1-2 degrees, it is acidic, and at 3-4 it becomes slightly alkaline and alkaline.
When a woman goes to the doctor, her complaints and examination carry a lot of information, but the smear analysis for flora is no less informative. The appearance of certain 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.
Thus, the analysis of a smear for flora is an important indicator of the functioning of the immune system, as well as the presence of dysbactriasis and chronic infections in a woman's body. If necessary, the doctor can do cytomorphological and bacterial examination of secretions, which are special methods of analysis.
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In gynecological practice, such a diagnostic method as a smear is used very widely and is used frequently. This is one of the main standard procedures to help assess the condition of the organs of the reproductive system in women.
Of course, absolutely all pathologies cannot be detected using this diagnostic method, but at least many of them can be suspected based on the smear results. That is why the analysis is paramount: it allows you to determine the course of further diagnostics, to select deeper and more informative research methods.
What do they pay attention to when deciphering the analysis?
Smear analysis allows you to evaluate indicators: leukocytes, squamous epithelial cells, key cells, mucus in the biomaterial, as well as the content of normal, pathogenic and opportunistic flora. The latter category includes yeasts of the genus Candida. From pathogenic microorganisms, using a smear on the flora, Trichomonas and gonococci can be detected.
A very important diagnostic indicator is the content of leukocytes. These cells of the immune system protect the body from foreign agents, whether they are microorganisms or destroyed or altered own structural elements.
It is leukocytes or white blood cells that rush to the pathological focus of inflammation in the body, wherever it is. And if the pathology develops in the organs of the reproductive system, these cells will go there.
In women, leukocytes in a smear for flora are always present, and their norm is a rather arbitrary concept. The fact is that in different parts of the genitourinary system, their permissible value differs. Most of the white blood cells in the cervical region; their smallest content is normally noted in the urethra.
However, for the diagnosis of inflammatory processes, it is important to evaluate not so much the number of leukocytes as their morphology. This is due to the fact that white blood cells, which have fulfilled their function of “cleansing” the body of pathogens, are destroyed. These white blood cells are called neutrophils.
In addition, it is important to take into account the fact that the concentration of white blood cells during the menstrual cycle changes under the influence of sex hormones, so if the white blood cells in the smear are slightly elevated, this is not necessarily a sign of a serious pathology.
In any case, the content of these cells should be evaluated only in conjunction with other diagnostic criteria: the composition of the normal flora and opportunistic microorganisms, the presence or absence of pathogenic bacteria, the number of epithelial and key cells.
As noted above, diagnostic material for a smear on the flora is collected from three points - the cervix, urethra and vagina.
And in each smear obtained, similar indicators are evaluated, but the norms of some of them differ depending on the area of localization. Below is a table explaining what is the norm for the content of leukocytes, normal and pathogenic flora, cellular elements and mucus in a smear in women.
| Diagnostic criterion | Normal performance | ||
| Vagina (V) | Cervix (C) | Urethra (U) | |
| Leukocytes (Le) | 0-10 | 0-30 | 0-5 |
| Slime | moderately | — | |
| epithelial cells | 5-10 | ||
| key cells | — | — | — |
| Microflora | Gram-positive rods (bifidus and lactobacilli) ++++ |
— | — |
| Yeast (Candida) | — | — | — |
| Trichomonas (Trich) | — | — | — |
| Gonococci (Gn) | — | — | — |
A smear that fully corresponds to the parameters of the norm is a rather rare phenomenon. However, minor deviations from the norm are allowed when it comes to the vagina. The urethra and cervix, if there are no pathologies, must be sterile - there should not be any microflora there. In relation to the vagina, the situation is ambiguous.
Depending on the content of various microorganisms, 4 degrees of purity are distinguished.
An ideal smear that does not contain leukocytes and pathogenic flora corresponds to the first. However, most women cannot boast of such results. Often in the vaginal discharge, individual leukocytes are found within the normal range (up to 10 pcs.), An insignificant content of epithelial cells and opportunistic bacteria. Such a picture is not characterized as pathological, and the smear belongs to the second degree of purity.
If gram-variable coccal flora, gram-negative rods or yeast cells are found in the vaginal discharge against the background of a decrease in the concentration of lactobacilli and bifidobacteria (Doderlein sticks), this is a reason for further diagnosis. Such a smear is referred to the third degree of purity. Leukocytes in it exceed the norm, and also contains a lot of mucus.
In a smear of the fourth degree of purity of the Doderlein sticks (normoflora), there is very little or none at all, leukocytes cover the entire field of view, the content of mucus and epithelial cells is increased. In addition, pathogenic microorganisms are found in large numbers. This condition requires prompt treatment.
If leukocytes are increased in a woman's smear, the reasons for this are associated with inflammatory processes. The greater the concentration of these cells, the more pronounced the process. However, this indicator should be evaluated in conjunction with other diagnostic aspects.
For example, an increase in mucus content is noted with the development of infections. So the body seeks to "clear itself" of pathogens. An increase in the number of epithelial cells, as well as leukocytes, warns of inflammation.
According to some laboratories, the content of these elements is allowed up to 10 in the field of view, but this indicator varies depending on the phase of the menstrual cycle and its values \u200b\u200bare not to be interpreted without regard to other diagnostic signs.
The key cells are called epithelial cells dotted with gardnerella bacteria. This is the so-called "bacterial sand". If such cells are detected in a smear, there is a high probability of developing bacterial vaginosis (gardnerellosis).
The detection of a large number of candida in a smear against the background of inhibition of normal flora is a sign of thrush. This is due to the fact that with a decrease in the concentration of Doderlein sticks that produce lactic acid, the pH of the vagina rises.
This condition leads to the active growth of opportunistic flora, including Candida. In an acidic environment, these microorganisms cannot multiply, and thus bifidobacteria and lactobacilli inhibit the process of vaginal colonization.
Gonococci and Trichomonas are pathogenic microorganisms. Under no circumstances should they be in a smear. The detection of these bacteria signals the development of gonorrhea or trichomoniasis.
Conception triggers a cascade of processes in a woman's body, and in order for all of them to proceed smoothly, a balanced work of the endocrine organs that produce hormones is important. A change in their balance causes powerful restructuring in the work of organs and systems.
So, sex hormones - progesterone and estrogens - stimulate the work of squamous epithelial cells. They begin to actively synthesize glycogen, which supports the reproduction of normoflora. By destroying this compound, Doderlein sticks produce a large amount of lactic acid, which acidifies the environment, and thus provides protection against infections.
However, against the background of a physiological decrease in immunity during pregnancy, this measure is often not enough. Many future mothers, when the balance of hormones changes, begin to suffer from thrush or other pathologies caused by opportunistic microorganisms.
Against this background, an increased content of leukocytes is noted in the smear. Often the concentration of such cells in the vagina in pregnant women exceeds the norm - up to 10 pcs. in one field of view.
It is important to note that the concentration of leukocytes in the urethra and cervix should not change. The norms of these indicators are the same as for non-pregnant women. Elevated white blood cells in the urethra are a sign of inflammation. This condition requires diagnosis and treatment.
During pregnancy, the white blood cell count should be monitored especially carefully, as it warns of the manifestation of chronic pathologies. It is better for a future mother to undergo an examination once again.
Like most diagnostic studies in medicine, a flora smear requires preparation. Going to the gynecologist, a woman should remember that the result of the analysis will be reliable only if the following recommendations are followed:
Intimacy, any topical application, antibiotics distort the data on the real state of the microbial biocenosis of the genitourinary system in a woman.
In the process of urination, diagnostically significant objects of research are washed off: cellular elements, microorganisms, which also changes the overall picture. Menstruation complicates the acquisition of material for diagnosis - it will be "contaminated" by a large number of red blood cells.
A smear in women involves taking biomaterial not only from the vaginal mucosa. Samples for analysis are also taken from the urethra, cervix.
After the onset of sexual activity, every woman should undergo this diagnostic procedure regularly: at least 1 time per year. In addition to preventive examinations, a smear should also be taken during pregnancy. If there are no alarming symptoms, the expectant mother will have to undergo this procedure twice: at the very beginning of pregnancy when registering and in the third trimester, after 30 weeks.
However, a significant reason for taking a smear is the appearance in any woman of both a pregnant woman and no following symptoms:
In addition, it should be remembered that prolonged antibiotic treatment can affect the vaginal microflora in a negative way: cause the death of beneficial bacteria, which will be replaced by opportunistic inhabitants. Against this background, candidiasis, bacterial vaginosis often develop and they can be diagnosed using a smear on the flora. That is why it is advisable to take such an analysis after completing a course of antibiotic therapy.
