Leukocytes 0 3 in p.s. Detailed explanation of smear analysis for flora in women. Collection of material for research

M microscopy of a smear from the cervix (cervical canal) and/or vagina, often called a “flora smear”, is the most common (and, frankly, the least informative) of all tests in gynecology. More often, material is taken from both the cervix and the vagina, but sometimes the doctor may decide to take from only one locus (for inflammation in the cervical canal, for example, only from the cervical canal; or for signs of a violation of the vaginal microflora, only from the vagina).

Microscopy allows you to assess in general terms the composition of the vaginal microflora, as well as count the number of leukocytes on the vaginal/cervical mucosa. For diagnosing STIs, as well as bacterial vaginosis, vulvovaginal candidiasis and aerobic vaginitis, a smear is not very informative, and therefore tactics “if everything is fine in the smear, there is no need to do further tests” fundamentally incorrect; More sensitive methods are needed to make these diagnoses.

It is believed that the main purpose of smear microscopy is identify inflammation on the mucous membrane of the cervical/vaginal canal, but today there are no standards for the number of leukocytes in the cervix, and therefore it is impossible to diagnose “cervicitis” (inflammation of the cervical canal) only by microscopy.

Let's look at what the parameters that are assessed during microscopy mean. As an example, we took a form from one of the laboratories; the type of form and the number of parameters may vary.

Leukocytes,cervix(in the field of view, hereinafter “in the field of vision”)

The number of leukocytes in a smear from the cervical canal in one field of view of the microscope.

The number of leukocytes reflects the presence/absence of inflammation on the mucosa. The norm is considered to be a leukocyte count of up to 10 per eye. In pregnant women, this figure can be much higher and normally can reach 30-40 in p/z. An increased number of leukocytes in the smear occurs in patients with ectopic columnar epithelium (sometimes called ““). If the number of white blood cells in the cervical canal is increased, a diagnosis of cervicitis is usually made.

Epithelium, cervix(in p/zr)

The number of epithelial cells (i.e. those cells that line the cervical canal) in a smear from the cervical canal in one field of view of the microscope.

There should be epithelium in the smear; this is an indication that the doctor “climbed” into the canal and obtained material from there. This indicator does not indicate normality/pathology, but only the quality of the smear itself.

Red blood cells, cervix(in p/zr)

The number of erythrocytes (red blood cells) in a smear from the cervical canal in one field of view of a microscope.

Normally there should be no red blood cells. Red blood cells appear if:

1. there is active inflammation of the mucous membrane,
2. There are non-inflammatory diseases of the cervix (both benign and malignant).

Microflora(quantity)

Bacteria that can be seen in a smear from the cervix.

There is no microflora as such in the cervical canal, but there is a transfer of bacteria from the vagina. Some bacteria can cause inflammation. The rods are most often lactobacilli, the normal flora of the vagina. Therefore, if we see rods in any quantity in the cervical canal, this is the norm. All other options are evidence of a violation of the vaginal microflora or an inflammatory process in the cervix itself.

Leukocytes, vagina(in p/zr)

The number of leukocytes in a vaginal smear in one microscope field of view.

The number of leukocytes reflects the presence/absence of inflammation on the vaginal mucosa. The norm is considered to be a leukocyte count of up to 10 per eye. In pregnant women, this figure can also be much higher and normally can reach 30-40 in p/z. Most often, the cause of inflammation in the vaginal mucosa is candida (“thrush”), trichomonas or intestinal flora. If the number of leukocytes in the vagina is increased, a diagnosis of Colpitis or Vaginitis is usually made.

Epithelium, vagina(in p/zr)

The number of epithelial cells (i.e., those cells that line the walls of the vagina) in a vaginal smear in one field of view of a microscope.

There should be epithelium in the smear. This indicator does not indicate normality/pathology, but only the quality of the smear itself.

Red blood cells, vagina(in p/zr)

The number of erythrocytes (red blood cells) in a vaginal smear in one field of view of a microscope.

Normally there should be no red blood cells. Red blood cells appear when

1. the doctor scratched the mucous membrane when taking the material (then the doctor will remember that blood appeared at the time the smear was taken),
2. there is active inflammation of the vaginal mucosa,
3. there are non-inflammatory diseases of the vagina (both benign and malignant).

Microflora(quantity)

Bacteria that can be seen in a vaginal smear.

This parameter mainly reflects the state of the vaginal microflora. Normally, there are rods (it doesn’t matter in what quantity, it is important that only they are present). Variants of conclusions - “mixed”, “cocco-bacillary”, “coccal” indicate disturbances in the composition of the vaginal microflora.

"Key" cells(quantity)

Normally they shouldn't be there. "Key cells" are one of the signs. However, their presence alone is not enough to make a diagnosis.

Fungal spores, fungal mycelium

Two forms of the existence of fungi (most often, candida) in the vagina.

Mycelium is a more “aggressive” form (an indicator of fungal activity), spores are an inactive form. More often, spores are found in healthy women, mycelium is found in candidiasis, but the dependence is not strict (that is, spores can also be present in candidiasis).

Mucus

Mucus may be normal in a smear from both the cervix and vagina. The amount of mucus does not indicate normality/pathology.

Trichomonas

Trichomonasvaginalis, a sexually transmitted infection. It shouldn't be normal. If detected, treatment is required.

Diplococcus(gonococci, Gram-diplococci)

Neisseriagonorrhoeae, a sexually transmitted infection. It shouldn't be normal. BUT! Other, non-dangerous bacteria may also look this way (for example, other Neisseria, which can normally live in the mouth and vagina). Therefore, when detecting diplococci by microscopy, additional examination is necessary using other methods, such as PCR to detect DNA Neisseria gonorrhoeae and/or sowing on Neisseria gonorrhoeae.

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 done?

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.

In 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.

The price of the study 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, 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
Mucus	Moderate/absent	Moderately	Moderately
	Not identified	Not identified	Not identified
Trichomonas	Not identified	Not identified	Not identified
Yeast fungi (Candida)	Not identified	Not identified	Not identified
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 mucus in the analysis is possible due to violation of hygiene rules, improper collection of biomaterial.

For vagina: leukocytes normal 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 test 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 organs of the urogenital tract. They may be elevated in the following diseases:

• specific or nonspecific urethritis;
• prostatitis;
• urolithiasis;
• 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. Mucus 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.

Good afternoon. Passed tests. Tell me, are the indicators normal? Is treatment necessary? (Male, 40 years old) Chlamydia trachomatis (qualitative) DNA not detected Mycoplasma hominis (half colony) DNA not detected Ureaplasma urealyticum+parvum (half colony) DNA not detected Gardnerella vaginalis (half colony) DNA not detected Neisseria gonorrhoeae (qualitative) DNA not detected Trichomonas vaginalis (quality) DNA not detected Mycoplasma genitalium (quality) DNA not detected Candida albicans (half-column) DNA not detected Herpes simplex virus I, II (quality) DNA not detected Microscopic picture: Cells of squamous and urethral epithelium . Mucus. Leukocytes - 0 - 1 in the field of view. Microflora - single gram (+) cocci in the preparation. Gram (+) coccobacilli are single in rare p/sp. Trichomonas and gonococci were not found in the obtained material.

ANSWERED: 05/23/2018

Hello, Denis. No urogenital infections were detected. There are cocci in the tests, but I would not like to see this indicator in the test results. Cocci are classified as opportunistic microflora; with an increase in their number, it is necessary to increase immunity; you can use miramistin and oflocaine ointments. I recommend discussing with your doctor the possibility of adding to therapy a drug that restores the effective functioning of local and systemic immunity - Galavit. Galavit is used in the complex treatment of urogenital diseases, as it not only restores the body's defenses, but also reduces the intensity of the inflammatory process, helps reduce the severity of unpleasant symptoms, accelerates recovery, increases the effectiveness of antimicrobial therapy and reduces the risk of the disease becoming chronic. For urogenital diseases, Galavit is used in complex therapy according to the following scheme: 1 day, 1 suppository twice rectally, then 1 suppository every other day. Course - 10-15 suppositories.

Clarification question

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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.

A 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 zones 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 lesions, 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 method 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:

Indicator	Normal values
	Vagina (V)	Cervical canal (C)	Urethra (U)
Leukocytes	0-10	0-30	0-5
Epithelium	5-10	5-10	5-10
Mucus	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.

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

This study allows you to assess 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 appropriate treatment.

When is the analysis performed?

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

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

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

2. Collection of material for research

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

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

Vaginal discharge is multicomponent, it includes:

1. 1 Mucus of the cervical canal - needed for the penetration of sperm into the uterine cavity and higher for fertilization. Its thickness depends on the level of estrogen in a woman’s body; its viscousness can be used to judge the phase of the menstrual cycle.
2. 2 Secretion of the glands of the external genitalia.
3. 3 Desquamated vaginal epithelium.
4. 4 Bacteria (vaginal flora). Normally, the microflora in the smear is represented by a large number of lactic acid bacteria (Gram-positive Doderlein bacilli) and a small amount of opportunistic flora (most often coccal).

2.1. Preparing for a smear collection

Before collecting material, a woman must meet certain conditions:

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

2.2. Technique for obtaining material

• A smear on the flora is taken strictly before a bimanual examination, the woman is on a gynecological chair.
• A Cusco-type bicuspid speculum is inserted into the vagina, and the vaginal part of the cervix is ​​exposed (exposed).
• Focusing on it, the doctor uses a special spatula to collect material from the posterolateral vaginal vault and transfers it to a glass slide, which, after filling out the directions, is delivered to the laboratory for microscopic examination.
• Analysis from the external opening of the urethra is taken with a bacteriological loop or a Volkmann spoon. If available, it is advisable to take them, lightly pressing on the outer hole from the outside.
• Analysis is taken from the surface of the vaginal part of the cervix with an Erb spatula.

3. How to decipher the results?

3.1. Normal flora

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

Normally, 95% of a woman’s flora consists of lactic acid bacteria (otherwise known as Doderlein bacilli, lactobacilli, lactobacilli).

During their life, lactobacilli process glycogen released from epithelial cells to form lactic acid. It is this that provides the acidic environment of the vaginal contents, which prevents the proliferation of facultative and pathogenic flora.

Each 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 amount of gram-positive rod flora (++++) is equated to grade 1 vaginal cleanliness. This is observed quite rarely; this situation is more typical for control smears after vaginal sanitation or taking antibiotics.

A small number of cocci (+, ++) is considered normal and indicates 2 degrees of purity, but only if rod flora (++, +++) is also detected. This is a good stroke.

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

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

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

3.2. Gonococci and Trichomonas (Gn, Tr)

3.7. Yeast-like fungi

– unicellular microorganisms of round shape. The vaginal environment is ideal for their growth and development due to the high glycogen content.

But due to the competing lactobacillary flora, with a normal level of immunity, their active growth is not observed. To acquire pathogenic properties, fungi of the genus Candida require certain conditions:

1. 1 State of immunosuppression,
2. 2 Presence of endocrine pathology,
3. 3 Malignant neoplasms,
4. 4 Pregnancy period, childhood and old age,
5. 5 Therapy with glucocorticosteroids.

Should not be detected. In exceptional cases, their single detection is allowed in material taken from the posterolateral vaginal vault, as a component 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 microscopy result with complaints and clinical manifestations.

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

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