Analysis for internal infections in women. List of latent infections in women. Tests for latent infections. How to prepare for the analysis
A smear for flora is a simple and fairly informative analysis that a doctor takes in women and men of all ages both for the purposes of routine diagnostics and in the case of acute or “erased” symptoms.
It allows you to assess the state of the microflora of the urogenital tract, to determine the presence of certain inflammatory diseases, infections, viruses.
Some doctors say that this analysis does not require special preparation, however, this is not so. For 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 your doctor 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 analysis after the end of menstruation, and besides, all patients should refrain from any sexual intercourse 2 days before taking the biomaterial.
How is the analysis given?
The analysis is most often taken by a doctor when you come to him for a regular appointment at a polyclinic or when you simply go to a paid laboratory where obstetricians and medical staff take biomaterial from you.
The pap smear procedure is completely painless.
Among women a gynecologist, obstetrician or any other medical worker lightly draws a special disposable spatula in the form of a stick at three points - vagina, urethra and cervical canal.
In men the urologist or another doctor inserts a special disposable probe into the urethra, rotates around the axis several times and takes an analysis. It is believed that the study does not cause pain, however, this does not exclude the negligence of the doctor, as well as individual sensitivity or the presence of a particular disease, which can cause discomfort.
Research price
The results of the flora smear are usually ready the next day, as the study is not specific and complex, so you can pick up your tests fairly quickly. smear on flora really considered a fairly simple study that can be done in a regular clinic for free. However, if the deadlines are running out or you simply do not trust the doctors from the clinic, then you don’t have to worry - a swab for the flora is taken in any paid medical laboratory.
Research costs vary. from 440 to 550 rubles and in addition, you can pay separately for the collection of biomaterial by a medical worker. The total will be approximately 900-1000 rubles.
The norm of smear results on flora in women
A smear on flora 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 characters are indicated in Latin letters on top: "U", "V", "C", which literally means urethra (urethra), vagina and cervical canal. Often they are written in full like this: "uretra", "vagina", "canalis cervicalis". Normally, the smear analysis indicators for flora in women should look like this:
| Indicators | Urethra (normal) | Vagina (normal) | Cervical canal (normal) |
| Leukocytes | 0-5 in p / c | 0-10 in p / c | 0-15-30 p / s |
| Epithelium | Moderate or 5-10 in p / s |
Moderate or 5-10 in p / s |
Moderate or 5-10 in p / s |
| Slime | Moderate/absent | Moderately | Moderately |
| Not found | Not found | Not found | |
| Trichomonas | Not found | Not found | Not found |
| Yeast fungi (Candida) | Not found | Not found | Not found |
| Microflora | absent | stick in large quantities or lactobacillus |
absent |
| key cells | missing | missing | missing |
Are you testing in a private clinic?
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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 as a whole. A slight excess or underestimation of the indicators can be considered by the doctor as an individual norm, but this is only permissible if there are no patient complaints, otherwise additional tests or a re-examination should be carried out.
Deciphering the results in women
For the urethra, vagina, cervical canal, as mentioned above, there are normal indicators. For the urethra: leukocytes should be in the normal range 0 to 5 in the field of view, epithelium moderate or from 5 to 10 or 15 in the field of view, mucus should be absent, 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 a foreign object, which requires immediate medical attention. Revealing , Trichomonas and Candida fungi indicates specific urethritis. Increased slime in the analysis is possible due to violation of hygiene rules, improper collection of biomaterial.
For the vagina: leukocytes fine must be 0 to 10 in view. However, during pregnancy leukocytes may increase, and therefore allowable rate in that case it will from 0 to 20 leukocytes in p / o.
This is not a pathology and does not require any special treatment.
The epithelium must be moderate or 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 in large or moderate amounts. An increase in the number of leukocytes in a smear indicates an inflammatory process in the vagina, which happens with the following diseases:
- colpitis;
- vaginitis,
- vulvoginitis (especially in girls under 14 years old);
- urethritis;
- cervicitis (inflammation of the cervix);
- oophritis (inflammation of the ovaries);
- andexitis (inflammation of the uterine appendages);
- sexual infection.
Excess quantity squamous epithelium is also a sign of an inflammatory process. A slight increase in indicators is acceptable at a certain phase of the menstrual cycle, when the hormone estrogen begins to increase. decline the number of epithelial cells occurs in women during the period menopause, as the production of the hormone estrogen begins to decline sharply.
Mucus in large quantities indirectly indicates an inflammatory process or non-compliance with hygiene rules. The microflora of the vagina 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 also quite common in smear results. It happens in girls under the age of 14, as well as in women during menopause, which is considered as a variant of the norm. Otherwise, such flora can mean the following conditions:
- ovarian hyperfunction;
- inflammatory diseases of the pelvic organs;
- venereal diseases;
- vaginal dysbiosis;
- beginning or end of menstruation.
coccobacillary microflora indicates an imbalance of bacteria in the microflora of the vagina, where pathogenic bacilli and cocci begin to predominate. The presence of such microflora indicates bacterial vaginosis or STIs. coccal flora often occurs with inflammatory diseases of the vagina, urethra, bacterial vaginosis (dysbacteriosis), etc. The usual violation of the microflora of the vagina cannot be any diagnosis.
Key cells, or rather their presence in a smear indicate gardenellosis or vaginal dysbiosis. For the cervical canal: leukocytes should be normal 0 to 15 or 30 in the field of view, epithelium moderate, A microflora, key cells, candida, trichomanads should be absent.
An increase in the number of leukocytes, epithelium indicates an inflammatory process of the pelvic organs, the presence of cancer, genital infections. Revealing fungus candida, trichomanas requires immediate treatment with antibiotics, as they should normally be absent.
The norm in men
In men, a smear on the flora is taken to study the amount leukocytes, epithelium, the presence of cocci, gonocci, trichomanads, mucus, microflora. For diagnosis, only detachable from the urethra (urethra). The results of the analyzes are also usually presented in the form of a table, where one column indicates the parameters studied, and the other - the results obtained. In men, the norm of smear results for flora 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 laboratory reference values must be taken into account, which can be indicated nearby in the right column.
Deciphering the results of men
In the results of a smear on the flora in men, it is normal the number of leukocytes should be from 0 to 5 per field of view, epithelium from 5 to 10 per field of view, cocci are present in a single quantity, mucus in moderation, and Trichomanas, gonococci, 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 can be elevated in the following diseases:
- specific or nonspecific urethritis;
- prostatitis;
- urolithiasis disease;
- the presence of benign and malignant neoplasms;
- stricture (narrowing) of the urethra.
An increase in the epithelium also indicates an inflammatory process or urolithiasis, and the detection of cocci is approximately above 4-5 in the field of view means the presence of acute or chronic non-specific urethritis caused by opportunistic bacteria. Slime in large quantities, it also indirectly indicates inflammation, but with other normal indicators, it can talk about sluggish urethritis, prostatitis.
Presence in analysis gonococci, trichomands, Candida fungi testifies in favor of specific urethritis and, accordingly, diseases of gonorrhea, trichomoniasis, candidiasis. In any case, the doctor must take into account all smear indicators for further diagnosis and treatment.
Analysis Disadvantages
In conclusion, it is worth noting that the main drawback of smear analysis for flora is inability to detect sexually transmitted infections in a patient, but in any case, the doctor should evaluate your condition, symptoms and smear results.
A smear for flora can be called verified and in a simple way studies of diseases of the urogenital tract, but not the only and not fundamental in the formulation of a particular diagnosis.
Often, doctors call this study "outdated", "ineffective" and when they receive 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 decision of the doctor and does not detract from the very specifics of the study. However, a standard swab for flora in any case does not lose its relevance, and its diagnostic value is still quite high and in demand.
To get tested for infection, woman just go to any private clinic or laboratory. It's best if it's medical Center specializing in the treatment of STDs. Because in this case, the patient will be able to get a doctor's consultation after passing the necessary studies.
What tests to pass on infection to a woman, in each case is determined individually. If there is absolutely no data suggestive of a possible pathogen, one has to be examined for all common STIs. Today, laboratories offer such examinations comprehensively, at an affordable price.
usually involves the search for pathogens of such diseases:
- chlamydia;
- mycoplasmosis;
- trichomoniasis;
- gonorrhea.
The list can be expanded.
Tests for sexually transmitted infections in women may include the determination by PCR of the genetic material of such pathogens in a smear:
- herpes;
- ureaplasmosis;
Analyzes for opportunistic flora In addition, using PCR, you can conduct a study on opportunistic flora. It is quantitative and involves an assessment of the ratio of different microorganisms in the woman's vagina.
In this way, infections provoked by:
- streptococci;
- staphylococci;
- coli;
- enterococci;
- gardnerella;
- candida;
- ureaplasma;
- mycoplasma.
An alternative study to assess the state of the microflora is an analysis for bakposev in women. Which infections are found depends on how clean the vagina is. In this way, it is possible to determine the causative agent of nonspecific vaginitis or to identify violations of the vaginal biocenosis.
Blood test for latent infections in women
Serological diagnostic methods are another group of tests for latent infections in women that a doctor can prescribe. They involve the determination of the level of immunoglobulins in the blood. These are antibodies produced in response to the penetration of the pathogen into the body.
Deciphering the analysis for latent infections in women with serological studies is impossible without the help of a specialist. Often defined different types immunoglobulins. They can be contained in different concentrations, evaluated in dynamics. Sometimes positivity coefficients are calculated.
Usually, such tests for sexually transmitted infections in women are given:
- viral hepatitis;
- herpes;
- cytomegalovirus;
- syphilis;
- chlamydia.
Analysis for papillomavirus infection in women
In the antenatal clinic, the patient takes not only a smear for the flora, but also a sample of the cervical epithelium for examination for oncocytology. When signs of atypia are found, an HPV test is often performed.
Papillomavirus is the main cause of cervical cancer. Therefore, it is important to determine which type of infection caused the disease. If it is type 16 or 18, the risk of developing cervical cancer is rated as high. In this case, you need to take measures to minimize it.
Where can a woman be tested for infection?
In our clinic, any woman can be tested for infections, the prices here are very affordable. The exact cost depends on a number of factors.
It is defined:
- the diagnostic method that is used;
- the number and type of pathogens that are tested in the clinical material.
The cheapest is a smear on the flora. PCR is also inexpensive, especially if the list of pathogens is small. Serological diagnosis is slightly more expensive. Tank sowing is inexpensive, given that several pathogens can be detected during sowing. Our clinic uses modern methods diagnosis of genital infections and nonspecific inflammatory processes. After passing all the tests, you can get advice from an experienced venereologist or gynecologist.
If you need to pass female tests for infections, contact competent venereologists and gynecologists.
Every female representative, especially if she has already entered into sexual life, it is recommended to visit a gynecologist at least once a year and take preventive tests in order to timely diagnose changes or diseases of the genital organs.
A gynecological smear for flora, as a diagnostic method, is recommended for every woman, even if she has no cause for concern.
A gynecological smear on the flora, or as it is also called, a bacteriological smear allows you to assess the condition of the epithelial cells, as well as identify pathogenic microorganisms such as yeast, trichomonas, gardnerella.
Also, thanks to the study of the flora, it is possible to evaluate those microorganisms that are considered normal for the female vagina, since the vagina, unlike the uterus, is not a sterile organ.
In the female vagina, it is normal to detect Candida, a fungus that is conditionally pathogenic, streptococci, staphylococci. An analysis of the flora will allow you to evaluate changes in the composition of microorganisms and timely identify bacterial pathology or, alternatively, suspect a disease of a different origin.
Unlike a smear for flora, a gynecological smear for cytology is a more difficult material to evaluate. To correctly evaluate the results of a cytology study, the doctor must have a special skill. True, the diagnostic event itself carries completely different information.
Any tests evaluating cytology primarily consider the cellular structure and changes in it. Thus, it is possible to suspect at an early stage, for example, an inflammatory process or other adverse changes in the cellular composition of the female vagina.
A cytology smear, in addition to the inflammatory process, helps to diagnose tumor diseases and papillomavirus infection, which can act as a trigger in the development of cervical cancer.
How to prepare for the analysis
Analyzes for cytology or flora do not require special preparatory activities, however, for reliable smear results in gynecology, a woman will have to follow a number of simple recommendations.
Preparation Tips:
- A few days before the study, it is recommended to abandon douching, vaginal tablets and ointments so that nothing affects the vaginal flora (it would be optimal to refuse procedures 2-3 days before the test).
- 1-2 days before the diagnostic event, it is recommended to refrain from sexual intercourse.
- In the evening before the procedure, hygienic procedures are performed without the use of intimate hygiene products.
- It is not necessary to perform hygiene procedures immediately before the examination (right before taking a smear from a gynecologist, you can easily wash the external genitalia warm water, but not more).
- Better to refrain from emptying Bladder a few hours before the study.
When choosing the day on which the tests will be carried out, it is worth considering the cycle of menstruation. For a smear on flora or cytology, the ideal time is a few days after the end of the menstrual cycle or before it begins.
Unlike a smear for flora, a smear for cytology is taken in the middle of the menstrual cycle, that is, not earlier than on the fifth day after the onset of menstruation, but not later than five days before the start of the next one. The rest of the preparation is the same.
If you predict menstrual cycle failed, the tests will have to be rescheduled to a later time. In most cases, the doctor prescribes the date of the study based on the woman's history, so such cases are quite rare and occur only with an unstable cycle.
How to take a smear from the vagina
The purpose of the procedure for taking a smear on the flora is to obtain mucus from the vagina, urethra and cervix. Typically, the study takes place in three main stages.
Before taking a smear on the flora, a woman must undergo a general gynecological examination using a “mirror” - a special tool whose task is to expand the walls of the vagina.
Gynecological examination is a common, safe and cheap procedure, but sometimes it can be inconvenient due to the temperature difference between the instrument used and the woman's body. Doctors note that examination with a “mirror” is easier if the patient relaxes and breathes evenly.
When the visual assessment of the condition of the walls of the vagina is completed, the specialist will collect mucus with a sterile swab. This procedure usually does not cause discomfort, but touching the tampon to the cervix may respond with mild pain, which disappears as soon as the manipulation ends.
The resulting mucus sample is transferred to a glass slide, after which it is taken to the laboratory, where it is examined under a microscope. A woman, depending on the workload of the laboratory, receives the results of a smear on the flora in the time interval from several hours to three days.
A smear for cytology is performed using a similar technique, but other data are evaluated in the laboratory under a microscope.
What diseases can be identified
A bacteriological smear, carried out in accordance with all the rules, allows you to determine the presence or absence of a number of typical inflammatory processes in a woman, which are provoked by pathogenic microorganisms.
Accordingly, during the study, a number of pathologies are diagnosed:
- Vaginitis- an inflammatory disease that affects the vaginal walls.
- cervicitis- a pathology that has an inflammatory nature and affects the cervical canal.
- Bacterial type vaginosis- a disease that develops if there are changes in the normal microflora of the vagina.
- Thrush or candidiasis- fungal infection of the genital organs, which occurs due to the excessive presence of Candida (they are opportunistic and may be present in a normal smear).
With the help of a bacteriological smear, a number of diseases that are sexually transmitted are also diagnosed. These include:
- Chlamydia- indulges mainly only sexually and is caused by chlamydia.
- Gonorrhea- an inflammatory disease that is provoked by gonococcal pathogens.
- Trichomoniasis- an infection caused by Trichomonas.
- Ureaplasmosis and mycoplasmosis- provoked by microbes of uraplasma and mycoplasma, affecting not only the genitals, but also the respiratory system.
If there is a need to clarify the results of a smear on the flora, then cultural studies can be performed (they will demonstrate how many microbes are in the genital tract), as well as a polymerase chain reaction, which is a method for diagnosing many diseases of the genitourinary system.
Cytological examination shows other pathologies. In total, according to cytology, five types of smears are distinguished, which allow one to judge the state of the female genital organs.
There are 5 types of cytology smears, depending on the results of the tests, they distinguish:
- Cellular changes were not revealed, the cervix is in its normal state;
- There are cellular changes in the form of an inflammatory process or mild dysplasia, in which case it is recommended to treat the inflammation and repeat the analysis;
- Cellular changes correspond to a moderate or severe type of dysplasia, additional diagnostic measures are required;
- Precancerous condition, consultation of an oncologist or oncogynecologist is required;
- Cancer, requires treatment in an oncology dispensary.
Despite the categorical description of the types of smears, women need to remember that a smear is an indicator of cellular changes, and you can find out their exact cause only after passing a full examination.
Cellular changes last stages in addition to the oncological process, it can mean the presence of the following diseases:
- papillomavirus type infection;
- parakeratosis of the cervix - changes in the epithelium that lead to disruption of the processes of keratinization;
- bacterial vaginitis, etc.
What to do with a bad smear
Bad results of a bacteriological smear should not cause a strong fear or nervous shock in a woman. She needs to remember that all infections that bacteriological analysis shows are treatable.
If the results are unsatisfactory, then you should follow three simple rules:
- Go through at least one more consultation with a gynecologist so that he can determine the cause of the disease, and if this is not possible, then prescribe additional diagnostic measures.
- Listen to the doctor's advice regarding the treatment of the identified pathology.
- Do not engage in independent attempts to recover at home, so as not to aggravate the process.
With a poor bacteriological smear, women are also banned from douching. This is due to the fact that it can further disrupt the microflora of the vagina, aggravating the course of the disease. When bad cytological examination the scheme of actions of a woman is almost the same.
The doctor, having determined the harmful changes in the cellular composition of the organ, necessarily sends the patient to undergo additional diagnostic studies, such as colposcopy and biopsy of the cervix. The final diagnosis is made based on the results of these studies, after which the pathology treatment begins.
Since cytology tests are screening, in most cases, pathological changes can be diagnosed in the early stages, when they are still well treatable if they are dealt with in a timely and correct manner.
Cytological and bacteriological analyzes in gynecology play an important role not only as screening studies, but also as diagnostic ones.
It is recommended that every female representative, especially if she has already become sexually active, visit a gynecologist at least once a year and take these tests for preventive purposes in order to timely diagnose changes or diseases of the genital organs and start treatment with the maximum possible efficiency.
Useful video about preventive examination by a gynecologist
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To diagnose the cause of diseases of the female reproductive system, a gynecological smear on the flora is used. This is a type of microbiological study that identifies opportunistic bacteria, often a normal component of the microbial flora of a healthy woman, and absolute pathogens that cause sexually transmitted diseases. Therefore, for the correct interpretation of the results, it is necessary to contact a specialist.
Indications for research
Signs of inflammation and the presence of infection - this is what a gynecological smear on the flora shows. Therefore, it is prescribed for the following complaints of the patient:
- itching in the perineum and vagina ();
- mucous or purulent discharge from the vagina;
- foul-smelling discharge, such as fishy.
A smear on the flora is also prescribed to healthy women for the purpose of early detection of infection:
- at the annual preventive examination;
- to monitor the effectiveness of antimicrobial therapy;
- before gynecological procedures and operations to prevent infection from entering other organs and blood;
- with prolonged use of antibiotics to exclude vaginosis and vaginal candidiasis;
- during pregnancy.
During pregnancy, a smear for the flora is taken three times: when a woman is registered in a consultation, at the 30th week and at the 36th week. This is necessary to exclude infection of the child during childbirth, as well as the penetration of pathogenic microbes into other tissues.
Study preparation
A smear should not be taken during menstruation. Optimal time- the middle of the cycle, from the 10th to the 20th day after the start of menstruation.
Preparation for the delivery of a smear on the flora is as follows:
- 2 weeks before the study, stop treatment with antibiotics or antifungal agents, if this is not possible, warn the doctor during the smear;
- refrain from vaginal sexual intercourse for 3 days;
- 2 days before the use of vaginal suppositories, tablets, creams and other dosage forms for local use;
- on the eve of the study, do not douche, you can only wash the perineal area with warm water and soap.
Smear procedure
A swab for flora in women is taken from the urethra, from the inside of the labia, the mucous membrane of the vagina and the cervix. It is also possible to obtain material for microscopy from the uterine cavity (with aspiration or curettage) and the ovaries (by puncture or during surgery). Smears are also prepared from this material.
Taking a gynecological smear for flora from the cervix
Smear technique:
- Urethra: A very thin swab on aluminum wire or a disposable bacteriological loop is used. The area of the external opening of the urethra is cleaned with a gauze swab. A loop or swab is inserted into the urethra to a depth of 1-2 cm, while slightly pressing on the side and back walls. The resulting material is placed on a glass slide by rolling the swab or moving the loop. It is used for microscopy and immunofluorescent analysis. To conduct a culture study or polymerase chain reaction (PCR), a swab or loop is placed in a test tube with a nutrient medium.
- Vaginal vestibule and labia: a sterile swab is applied. The material is taken from the inflamed area. With an abscess of the glands of the vestibule, it is first opened, and then the resulting contents are transferred to a glass slide.
- Vagina: with the help of mirrors, the lower part of the vagina with the neck is exposed. The tampon is placed on a visible area of inflammation or, in its absence, in the posterior fornix of the vagina. The material is evenly transferred to a glass slide, dried in air, fixed with ethanol (2-3 drops per glass), labeled, placed in a closed container and sent to the laboratory. If a culture study is necessary, for example, with trichomoniasis, the swab is placed in a test tube and immediately sent to the laboratory assistant.
- Cervix: First, culture is taken with a cotton swab. The cervix is moistened with sterile saline, the swab is carefully inserted into the cervical canal, and then removed without touching the vaginal walls, and placed in a sterile tube. To take a smear for microscopy, PCR or virological analysis, a special brush is used. It is placed in the cervical canal after taking the material for a cultural study. The depth of injection is 1-2 cm, the brush is gently rotated, then the resulting scraping is transferred to a glass slide.
Pap smears are fast, painless and safe.
microscopic examination
Smear microscopy makes it possible to:
- preliminarily determine which microorganisms and in what quantity are present in the focus of the disease;
- evaluate how technically the material for analysis is taken correctly (for example, in a smear from the cervical canal there should be no cells from the vaginal wall);
- to identify some microorganisms, for the cultivation of which special nutrient media are needed - gonococcus, Trichomonas, anaerobes.
Even with ordinary microscopy, strict anaerobic bacteria can be detected. They are part of a healthy microflora, but when accumulated in large quantities, they become the cause of bacterial vaginosis. At the same time, fusobacteria, bacteroids, and gardnerella are detected in smears.
Facultative anaerobes are outwardly similar, but their sensitivity to antibiotics is different. Therefore, if such microbes are detected, further cultural research is carried out.
Thus, smear microscopy is very important for diagnosis. It also detects cytolytic vaginosis and vaginal epithelial atrophy, which occurs in women after menopause.
Smear microscopy is necessary for the diagnosis of such diseases:
- (smears from the urethra and cervical canal);
As a result of the analysis, the doctor receives data on the state of the vaginal epithelium, the severity of inflammation and the composition of the microflora.
Microscopic examination results
To determine the total contamination by microorganisms, the following criteria are used:
- when up to 10 microbes are detected in the field of view - minimal (+);
- 11-100 cells - moderate (++);
- 100-1000 cells - a large number (+++);
- more than 1000 cells - a massive amount (++++).
A qualitative analysis is also carried out, determining which microorganisms are visible in the smear. To do this, it is painted different ways- according to Gram or according to Romanovsky-Giemsa. In conclusion, the doctor reflects the detected microorganisms and their number.
Normal indicators in the study of the microflora of the vagina:
- lactobacilli - up to 10 7 - 10 9 CFU / ml;
- bifidobacteria - up to 10 7;
- corynebacteria, streptococci - up to 10 5;
- clostridia, propionibacteria, mobilunkus, peptostreptococci, staphylococci, Escherichia coli, bacteroids, prevotella, candida - up to 10 4;
- porphyromonas, fusobacteria, veillonella, ureaplasma, mycoplasma - up to 10 3.
CFU is a colony-forming unit, that is, one microbial cell. When cultivated on a nutrient medium, it will multiply and form a separate colony.
The sensitivity of light microscopy is in the range of 10 4 -10 5 CFU/ml. Therefore, those bacteria that are contained in the discharge in smaller quantities may not be detected, and this is normal.
Sometimes the interpretation of the results does not contain a detailed listing of the detected bacterial species. In this case, in the analysis form, you can see the terms:
- sticks (this is the normal microflora of the vagina);
- cocci (round-shaped bacteria, often causing inflammation - streptococcus, staphylococcus aureus);
- mixed flora (usually found in bacterial vaginosis).
Also, as a result of the study, there may be indications of the presence of a large number of squamous epithelium and leukocytes (indicators of inflammation), as well as mucus and "key" cells - epitheliocytes, surrounded on all sides by bacteria.
Purity Determination
According to the results of microscopy, the doctor makes a conclusion about the so-called degree of purity of the vagina. There are 4 such degrees:
- Very rare in women who are sexually active
An acidic environment is determined, up to 10 leukocytes and epithelial cells, a small amount of mucus. The microflora is represented by lactobacilli, other microorganisms can be only single.
- The norm corresponds to the complete health of the genital organs
Unlike the first degree, the discharge medium is slightly acidic, gram-positive cocci are present in a small amount.
- Signs of colpitis - inflammation of the walls of the vagina
The medium is neutral, there are more than 10 leukocytes and epithelium in the field of view, a moderate amount of mucus, "key" cells. Pathogenic microorganisms are present (gram-positive and gram-negative rods, cocci), and the number of lactobacilli is less than normal.
- Severe inflammation
The medium is neutral or alkaline, there are more than 30 leukocytes, epithelium and mucus in large quantities. Pathogenic microorganisms in large quantities, corresponding to different degrees of microbial contamination. Lactobacilli may be absent.
The rate of leukocytes during pregnancy, as well as other indicators of microbiological research, are the same as in a non-pregnant woman. An increase in the number of leukocytes, epithelium, or the appearance of pathogenic microorganisms indicates the development of an inflammatory process and requires treatment.
Cultural study
If pathogenic bacteria are found in a smear on the flora, it is necessary to establish their type and sensitivity to antibiotics. For this, a cultural study is used. This is the main method for recognizing gonorrhea, trichomoniasis,.
Determination of sensitivity to antibiotics is especially important in infections caused by opportunistic microbes. It should be borne in mind that sometimes they are in the vagina in a rather small amount, and are not distinguished by conventional microscopy. Therefore, only a cultural study is able to detect such microbes.
For analysis, the material obtained by taking a smear is placed on a special nutrient medium and cultivated, that is, kept under favorable conditions for some time. Bacteria at the same time begin to multiply, their number increases, and it becomes possible to identify them. After determining the leading pathogen, an analysis of its sensitivity to antibacterial drugs is carried out. Therefore, the analysis takes quite a long time - up to a week.
With the help of a cultural study, it is possible to detect pathogenic fungi, E. coli, staphylococci, streptococci, corynebacteria, neisseria, enterococci and other microbes and prescribe proper treatment infections.
Smear results for some pathological conditions
It is better to entrust the interpretation of the result to a specialist. However, a woman has the right to independently determine how well the state of her reproductive system is. Below are examples of the most common conclusions for various gynecological diseases.
Bacterial vaginosis:
- there are cells of the surface epithelium, often there are "key" cells;
- leukocytes are normal;
- the total number of microbes is large or massive (10 9 CFU / ml or 9 lg CFU / ml);
- gardnerella and anaerobes predominate, lactobacilli are absent (less than 10 5 CFU / ml);
- when cultivating in the presence of air, there is no growth of microorganisms, or there is a small amount of opportunistic flora, since anaerobes die in air.
Candida vaginitis:
- the epithelium is not only superficial, but also from intermediate and even deep layers, depending on the severity of the lesion;
- leukocytes from 10 to 50 or more in the field of view;
- the total number of microbes is not more than 10 8 CFU / ml, of which lactobacilli more than 10 6 CFU / ml;
- yeast fungi are determined in an amount of more than 10 4 CFU / ml;
- if the fungi are found in an amount of less than 10 4 CFU / ml, this is an asymptomatic carriage of candidiasis.
With a combination of candidiasis and vaginosis, changes in both types are noted simultaneously, but lactobacilli are replaced by gardnerella and anaerobes.
Nonspecific vaginitis:
- there is a superficial and intermediate, less often parabasal epithelium in large quantities;
- leukocytes more than 10 in the field of view;
- the total number of microbes is moderate;
- E. coli or gram-positive cocci predominate;
- lactobacilli are absent or isolated.
Vaginal epithelial atrophy (normal in older women):
- the epithelium is intermediate and parabasal, that is, the surface cells disappear;
- leukocytes up to 10 in the field of view;
- microorganisms, including lactobacilli, are not detected, or their number is extremely low (up to 10 4 CFU / ml).
With specific ones caused by sexual infections, trichomonas, chlamydia, gonococci and other similar pathogens are found in the smear. The rest of the picture will correspond to nonspecific vaginitis.
