Examination of genital secretions. Laboratory examination of genital secretions Examination of female genital secretions
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You need to visit a gynecologist once every six months. This will keep women’s health under control and identify diseases in time. The simplest and most accessible research method in gynecology is taking a gynecological smear.
Deciphering such an analysis will allow the doctor to see changes in the woman’s reproductive system that are not visible during an external examination.
- Taking a smear is a completely painless procedure and will only take a couple of minutes. It does not pose a health hazard and can be performed even on pregnant women.
When should you take a smear test?
Deciphering a smear analysis of flora can tell a gynecologist about the presence of sexually transmitted infections, an inflammatory process, and hormonal disorders in a woman’s body.
A flora smear (gynecological smear) is required if a woman has the following complaints:
- Discharge of an unusual color from the genital tract.
- Abdominal pain at rest or during sexual intercourse.
- Feeling of itching and burning in the genital area.
- The appearance of an unpleasant odor in the discharge.
Swabs are also taken during preventive examinations.
Interpretation of smear results
Using letters, the doctor marks the place where the smear was taken. Usually the letters of the Latin alphabet are used: V, C, U.
Smears are taken from three points: the vagina (V-vagina), cervix (C-cervix) and urethra (U-urethra).
In deciphering a smear for flora in women, you can find the strange word “cocci”. Cocci are microorganisms that have a round shape. This is a group of opportunistic organisms that are constantly present in the body.
However, they must be in a certain quantity. As soon as their number exceeds the permissible limit, 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 important diagnostic value in determining the pathogenicity of the microorganism that has settled in the vagina.
Coccus flora in a smear, gr.+ or gr.- cocci
smear on the flora of coccus bacilli
The division of microbes into gram-negative and gram-positive appeared in microbiology after a Danish scientist named Gram discovered the ability of microorganisms to turn different colors, depending on the degree of their resistance to antibiotics.
When coloring the preparations, a special dark blue or purple dye was used. The scientist noticed that some microbes are painted blue, while others are pink, although the dye is the same.
After careful research, it was found that microbes colored pink or crimson are less sensitive to antibiotics. In order for their death to occur, considerable efforts must be made.
Microorganisms that stained well in blue were called gram-positive (gram+), and those that remained pink were called 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 is more complex than that of gram(+) cocci, which means that it is much more difficult for a dye or antibiotic to penetrate its layers.
This division is important for a gynecologist. Detection of gram(+) cocci in a smear is allowed. These microorganisms include staphylococcus and streptococcus, which can 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.
What are Dederlein sticks?
An essential element of women's health is the rod flora in the vagina. Dederlein's rods are a generalized name that combines large and immobile gram-positive rods that provide 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:
- They help maintain an acidic environment in the vagina, which ensures careful selection of sperm during fertilization.
- As you know, sperm do not live long in an acidic environment. Therefore, inferior, weakened male cells die first, which allows only the strongest and most resilient to reach the goal.
- Suppress the development of pathogenic microorganisms through the activation of macrophages.
- Hydrogen peroxide is released - helps to “maintain cleanliness” in the vagina.
In a smear of a healthy woman, Dederlein bacilli should be present in large quantities. A decrease in their number indicates possible problems with women's health.
What is Leptotrix in a smear?
Leptotrix belongs to opportunistic microorganisms. This is a gram(+) anaerobic bacillus that inhabits water bodies. Under a microscope, leptothrix has the appearance of a hair - a long and thin rod.
It is believed that leptothrix are not sexually transmitted, and their presence in a smear is not a cause for concern if no other abnormalities are detected.
The peculiarity 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 leptothrix is detected during pregnancy planning, treatment is mandatory. It has been revealed that they can cause miscarriages, cause inflammatory processes in the membranes, and infect the child.
smear test
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:
- Flat epithelium (s.ep.) - normally its number 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.
- Leukocytes (L) – These cells are allowed to be present as 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.
- Dederlein sticks - a healthy woman should have a lot of them. A small number of lactobacilli indicates a disturbed vaginal microflora.
- Mucus – should be present, but only in small quantities.
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)
Index | Normal values | ||
Vagina (V) | Cervical canal (C) | Urethra (U) | |
Leukocytes | 0-10 | 0-30 | 0-5 |
Epithelium | 5-10 | 5-10 | 5-10 |
Slime | Moderately | Moderately | |
Gonococci(Gn) | No | No | No |
Trichomonas | No | No | No |
Key cells | No | No | No |
Candida (yeast) | No | No | No |
Microflora | A large number of Gram+ rods (Dederlein rods) | No | No |
Degrees of vaginal cleanliness
Often the doctor writes out a referral for a smear test for purity. Using this method, the “degree of cleanliness” of the vagina is determined. There are four of them in total. Only the first and second degrees are normal; the third and fourth degrees indicate the presence of diseases of the genital tract.
1st 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 bacilli, mucus and desquamated epithelial cells in small quantities.
2nd degree – The most common variant of the norm, in which leukocytes are within normal limits, mucus and epithelium are in moderate quantities. A small number of cocci or Candida fungi appear, and large quantities of lactobacilli appear.
3rd degree – a large amount of mucus and epithelial cells is detected in the smear. There are few beneficial lactobacilli; instead, there is an increased number of Candida fungi and pathogenic microbes.
4th degree – there are so many leukocytes that the doctor describes them as “entirely”. A very large number of pathogenic microorganisms. Dederlein rods are missing. Mucus and epithelium in large quantities.
The first and second degrees do not require treatment, but the last two degrees indicate an inflammatory process caused by one or another pathogen and require immediate treatment.
Flora smear during pregnancy
During 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 to prevent diseases of the genital area, which can complicate childbirth or cause diseases in the newborn.
The smear readings 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 rods increases tens of times. This is necessary to maintain an acidic environment, which has a destructive effect on pathogenic microbes, protecting the fetus from infection.
The number of epithelial cells also increases. During pregnancy, they accumulate glycogen reserves, which are used by lactobacilli as food.
Otherwise there are no differences. The appearance of pathogenic microorganisms also requires treatment, only more gentle methods of therapy are chosen (suppositories, tampons, ointments).
Federal Health Agency
and social development
Stavropol State
medical Academy
Faculty of Postgraduate Education
Subject: Study of discharge from female genital organs
Scientific adviser:
Doctor of Medicine, Professor
Pervushin
Performed:
Cadet cycle
"Clinical laboratory diagnostics"
Borozdina I.B.
Stavropol, 2008
Introduction
Chapter I. Theoretical foundations for the study of discharge from the female genital organs
Chapter II. Characteristics of nonspecific and specific focal processes of the vagina, cervix and uterine cavity
Conclusion
Introduction
Gynecological examination is a set of research methods with the help of which the anatomical and functional state of the genital area is determined and diseases of the genital organs are identified.
The relevance of the problem of studying gynecological smears is due to the fact that cancer of the body and cervix in frequency occupies one of the first places among malignant neoplasms in women.
Currently, all economically developed countries have seen a decrease in the incidence of cervical cancer. The main direction in the fight against this disease is its active detection during mass preventive examinations of practically healthy women, as well as timely diagnosis and rational treatment of background and precancerous diseases of the cervix, which is carried out in women's examination rooms and antenatal clinics.
The women's examination room is part of the prevention department. Tasks office are the implementation of preventive examinations of women from 18 years of age for the purpose of early detection of gynecological diseases, precancerous and cancerous diseases of the female genital organs and other visible localizations (skin, mammary glands).
Active detection of cancer patients, especially with initial forms of cancer in the preclinical stage of the disease, is the basic principle of gynecology and oncology.
From the standpoint of active detection of dysplasia and early cervical cancer, organizational issues of conducting mass gynecological examinations are of utmost importance, one of which is the rational organization of the cytological service, designed to ensure maximum efficiency of examinations by conducting cytological studies for each examined woman.
Conducting mass gynecological preventive examinations includes 2 main tasks:
Early and timely detection of cervical cancer, including in the preclinical stage of the process.
Identification of various non-tumor diseases requiring active treatment.
Fulfillment of these tasks leads to a decrease in the incidence of cancer, a decrease in the number of advanced forms and improved treatment results.
Preventive examinations of women are carried out at least once a year by a midwife or gynecologist in examination rooms at clinics, at enterprises, as well as during medical examinations of persons working in conditions of occupational hazard.
Chapter I. Theoretical foundations for the study of discharge from the female genital organs
The material for research most often is vaginal discharge, smears from the surface of the cervix, smears from the cervical canal and suctions from the uterine cavity.
They also examine smears - prints, scrapings from the mucous membrane of the female genital organs.
The study can be carried out over time, both in stationary and laboratory conditions.
Preparation and coloring of preparations.
Smears are taken from the upper-lateral part of the vaginal vault. The freely detachable material is applied to the edge of the glass slide and smeared with a slight movement using the edge of another ground glass.
Before staining, the smear is air dried.
As retainer use 96° ethyl alcohol, Nikiforov’s mixture, consisting of equal parts of 96° ethyl alcohol and ether, Leishman’s solution (consisting of 1 liter of methanol and 2.5 g of Leishman’s paint), and also fix it over the burner flame.
Coloring strokes. There are monomorphic and polymorphic methods for coloring smears.
At polymorphic methods Cell colors, depending on their type and the physicochemical properties of the cytoplasm, are colored differentially in red-orange or blue-green colors.
Monomorphic methods.
Hematoxylin-eosin staining. The smear is dried in air, fixed in Nikiforov's mixture or in 96° ethyl alcohol for 7 - 10 minutes. Then they are stained with an aqueous solution of hematoxylin (hematoxylin - 1.0 g, potassium alum - 50.0 g, sodium iodide - 0.2 g, distilled water - 1000 ml. The solution is kept in the light for 14 days, after which it is ready for consumption). For 7 - 10 minutes until a faint violet color is obtained. Next, the smear is washed with running water and stained with a 0.3% alcohol solution of yellowish eosin or a 1% aqueous solution of eosin for 1 minute. Then rinse again with running water and dry.
Stained with methylene blue. Apply 1 - 2 drops of a 1% aqueous solution of methylene blue to the dried preparation and cover it with a cover glass. After 1 - 2 minutes, the preparation is washed with distilled water until discoloration, which is done as follows: 1 - 2 drops of distilled water are applied to one edge of the smear, and filter paper is brought to the other. Then it is dried and microscopically examined.
Fuchsin staining. Apply to the dried preparation for 1 minute. Fuchsin solution (3 g of fuchsin is dissolved in 1 liter of 96° alcohol and 100 ml of distilled water is added to 12 ml of this solution). Then they are washed with water, dried and examined under a microscope.
Leishman staining technique. Air-dried preparations are poured with Leishman's paint for 3 minutes, while the preparation is simultaneously fixed. After this, rinse with tap water and pour in azur - eosin mixture (40 ml. 0.1% azur II and 30 ml. 0.1% eosin K) for 15 - 20 minutes. Then rinse with tap water, air dry and microscope.
Staining technique according to Romanovsky. Strokes fixed with 96° alcohol or Nikiforov’s mixture are filled with a working solution of Romanovsky-Giemsa paint for 20 - 25 minutes. Then rinse with running water and dry.
Polychrome methods.
Papanicolaou staining. The smears are fixed in Nikiforov’s mixture for 25 minutes, after which they are passed through a series of alcohols of decreasing concentrations: 96°, 80°, 70° and distilled water (the smears should be rinsed in each solution). Next, the smears are stained with Harris or Bommer hematoxylin for 50 minutes. Wash in 2 vessels with distilled water for 1 - 2 seconds and differentiate in a 3% solution of ammonium hydroxide (1 min). After differentiation, the smears are passed through alcohol of increasing concentrations: 70° (twice), 80°, 95°. Stain with a solution containing orange G dye (1 min) and pass through 2 vessels with 70° alcohol. Then the smears are stained with a polychrome dye for 1.5 minutes and passed through 95° alcohol in 3 vessels, then through a mixture of equal parts of absolute alcohol and xylene. Through xylene (1 min) and placed in Canada balsam.
Staining according to Dokumov. Wet smears are fixed for 30 minutes with Nikiforov's mixture, after which, without drying, hematoxylin is poured onto them for 2 - 3 minutes, after which the smears are drained and washed with running water. Next, the smears are stained with polychrome dye for 1 - 2 minutes, then it is drained, the preparations are washed with 70° and 95° alcohol, dried and placed in Canada balsam.
During all stages of painting, the smears should not dry out.
Polychrome dye: erythrosine - 0.25 g, lichtgrün - 0.2; phosphotungstic and phosphomolybdic acids 0.2 each; orange G - 0.1 g; glacial acetic acid - 1 g; ethyl alcohol - 50° - 100 ml.
The dye solution is kept for several days to mature.
Morphological features of the vaginal epithelium.
The composition of the epithelial cells of the vaginal discharge normally, like the histological structure of the integumentary multilayered squamous epithelium of the vagina and the vaginal part of the cervix, reflects the state of ovarian function.
During the proliferative phase, the stratified squamous epithelium reaches a thickness of 300 - 400 microns, has well-defined signs of vertical anisomorphy, and consists of three layers: basal, intermediate and superficial.
During the secretory phase of the menstrual cycle, the stratified squamous epithelium has a thickness of up to 200 microns. Some of the cells of the functional layer above the papillae are desquamated. Glycogen is found in the form of minor accumulations in individual cells of the intermediate and functional layers. In the subepithelial papillary layer of connective tissue, accumulations of lymphoid cells and histiocytes are visible.
During the desquamative and regenerative phases, desquamation of most of the cells of the functional and intermediate layers is observed. The multilayer layer preserved on the surface of the mucous membrane consists of only 4 - 12 layers and a thickness of up to 42 - 96 microns.
In women who are in menopause and menopause, the stratified squamous epithelium undergoes atrophy.
Let us consider the structure of multilayered squamous epithelial cells.
Cells superficial epithelium large (40 to 50 microns in diameter), mostly polygonal, less often round or oval with clear boundaries. The cell nuclei are centrally located, small, intensely colored, pyknotic, with a diameter of no more than 6 microns. The cytoplasm is light blue when stained according to Leishman, Romanovsky-Giemsa, and small vacuoles are detected.
A large number of epithelial cells with pyknotic nuclei indicates high estrogenic activity. The smears are richest in surface epithelial cells in the late follicular phase.
Cells intermediate layer stratified squamous epithelium normally makes up no more than 10%. Their shape is polygonal or oval. Cell diameter is 25 - 30 microns. The cytoplasm is stained basophilic. The nuclear-cytoplasmic ratio is increased. The shape of the nuclei is vesicular, round or oval. Chromatin is delicately reticulated or delicately granular. The cells are arranged separately and in the form of layers of different sizes.
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 Scheduled preventive examinations and medical examinations.
- 2 Pathological leucorrhoea (vaginal, cervical, urethral discharge), unpleasant odor, profuse nature, discoloration.
- 3 Pre-conception preparation as part of planning natural and IVF-induced pregnancy.
- 4 Screening during pregnancy.
- 5 Unpleasant, painful sensations in the lower abdomen, which the woman does not associate with the menstrual cycle.
- 6 Painful urination, dysuria, including symptoms of urethritis, cystitis. Urological pathology in women, as a rule, requires consultation and examination by a gynecologist.
- 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 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 Secretion of the glands of the external genitalia.
- 3 Desquamated vaginal epithelium.
- 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 It is better to take the analysis on days 5-7. The collection of discharge is not carried out.
- 2 Avoid the use of vaginal suppositories, lubricants, douching and sexual intercourse 24 hours before the test.
- 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 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 State of immunosuppression,
- 2 Presence of endocrine pathology,
- 3 Malignant neoplasms,
- 4 Pregnancy period, childhood and old age,
- 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).
This is a study that allows you to determine the composition of the microflora of a woman’s genitourinary organs (urethra, vagina and cervical canal), the number of leukocytes, epithelium and their ratio, the amount of mucus and the morphological type of bacteria, as well as identify a number of specific pathogens, such as Candida fungi, Trichomonas and gonococci .
Synonyms Russian
Study of vaginal microbiocenosis with microscopy.
SynonymsEnglish
Gram's Stain. Bacterioscopic examination of smears (vaginal, cervical, urethral).
Research method
Microscopy.
What biomaterial can be used for research?
Smear on a glass slide.
How to properly prepare for research?
General information about the study
The normal microflora of a woman’s genitourinary organs includes about 40 types of bacteria. The dominant microorganisms in women of reproductive age are lactic acid bacteria (lactobacillus), which make up 95-98% of the total vaginal microflora. Due to the production of hydrogen peroxide and lactic acid, lactobacilli suppress the proliferation of pathogenic microorganisms and create an acidic environment (pH = 3.8-4.5). The rest of the normal microflora is represented by staphylococci, corynebacteria, klebsiella, Escherichia coli, gardnerella and anaerobes (bacteroides, prevotella, micrococci, vibrios of the genus Mobilincus, enterococci, peptococci, peptostreptococci, veillonella, clostridia, eubacteria, campylobacter, fusoba actors, etc.). Yeast-like fungi of the genus Candida may occur in small quantities. If there are fewer lactobacilli, the microflora balance is disrupted and the number of opportunistic microorganisms (streptococci, staphylococci, E. coli, etc.) increases, which can lead to dysbiosis. Vaginal dysbiosis threatens inflammation of the uterus and its appendages, infertility, ectopic pregnancy, miscarriage, and the birth of a premature baby. Its development is caused by non-compliance with personal hygiene rules, hormonal disorders (lack of estrogen), metabolic disorders, and the use of broad-spectrum antibiotics.
Microscopic examination of the discharge of the genitourinary organs allows a semi-quantitative assessment of the general microbial contamination, the condition of the vaginal epithelium, the presence and severity of inflammation (based on the leukocyte reaction), the composition of the microflora, as well as identifying thrush, trichomoniasis and gonorrhea. This method is the “gold standard” for diagnosing bacterial vaginosis (sensitivity – 100%). Microscopic examination reveals the following indicators:
- must be present flat epithelium, its absence may be due to atrophy of epithelial cells, a lack of estrogen or an excess of male sex hormones,
- quantity leukocytes should not exceed 15 in the field of view, its increase indicates an inflammatory process,
- slime,
- rods (bacilli) the smear contains the normal microflora of the vagina,
- cocci and diplococci– detection of gram-negative diplococci in a smear indicates gonorrhea,
- “key” or atypical cells are characteristic of vaginal dysbiosis,
- fungal spores or mycelium indicates candidiasis (thrush),
- Availability motile bacteria in a native smear ( trichomonas) characteristic of trichomoniasis,
- red blood cells are detected during bleeding from the uterus, erosions or neoplasms.
What is the research used for?
- To assess the composition of the microflora of the genitourinary system.
- For the diagnosis of bacterial vaginosis.
- To identify some specific sexually transmitted infections (candidiasis, trichomoniasis, gonorrhea).
When is the study scheduled?
- For symptoms of dysbiosis or inflammatory diseases of the genitourinary system.
- During preventive examinations.
What do the results mean?
Reference values
Reference values for various types of microorganisms depend on their location (point of collection of biological material).
Based on the microscopic picture, 4 types of vaginal microbiocenosis are distinguished.
Type of microbiocenosis |
Description |
Normocenosis |
The dominance of lactobacilli, the absence of gram-negative microflora, spores, mycelium and pseudohyphae, the presence of single leukocytes and “pure” epithelial cells. This type of smear is a normal variant. |
Intermediate |
Moderate or reduced number of lactobacilli, the presence of gram-positive cocci and gram-negative rods, leukocytes, monocytes, macrophages, epithelial cells. This type of smear is often seen in healthy women and is rarely accompanied by obvious symptoms. |
An insignificant number or complete absence of lactobacilli, abundant polymorphic gram-negative and gram-positive rod and coccal microflora, the presence of “key” cells, a variable number of leukocytes, absence or incompleteness of phagocytosis. Along with this, gardnerella, mycoplasma, ureaplasma, vibrios of the genus Mobiluncus, and anaerobic cocci are often found. |
|
Polymicrobial picture of the smear with a large number of leukocytes, macrophages, epithelial cells, with pronounced phagocytosis and the almost complete absence of lactobacilli. If pathogens of specific infections are detected (gonococci, trichomonas, pseudohyphae spores), the presence of gonorrhea, trichomoniasis or candidal vaginitis can be assumed. |
What can influence the result?
Local use of antiseptics, antibacterial, antifungal and contraceptive drugs.
Important Notes
- Microscopy of the discharge of the genitourinary organs is an “indicative” study. To accurately identify the pathogen and determine its sensitivity to antimicrobial drugs, a bacteriological study is performed - culture of material with determination of sensitivity to antibiotics.
- Viruses, chlamydia, mycoplasma and ureaplasma are not detected in a urogenital smear, therefore other methods are used to diagnose infections caused by these microorganisms - polymerase chain reaction or enzyme immunoassay.
- Culture of flora with determination of sensitivity to antibiotics
- Candida albicans, DNA [real-time PCR]
- Gynecology. National leadership / ed. IN AND. Kulakova, G.M. Savelyeva, I.B. Manukhina. – M: GEOTAR-Media, 2009. – 1150 p.
- Ankirskaya A.S. Bacterial vaginosis: features of the clinical course, diagnosis and treatment / Ankirskaya A.S., Prilepskaya V.N., Bayramova G.V., Muravyova V.V. // Rus. honey. magazine. – 1998. – No. 5. – P. 25-29.
- Savicheva A.M. Microbiological diagnosis of sexually transmitted infections / A.M. Savicheva // Consilium-medicum. – 2007. – T. 9, No. 6. – P. 38-43.
- Savicheva A.M. Laboratory diagnosis and therapy of reproductively significant infections / A.M. Savicheva // Treatment. doctor. – 2008. – No. 3. – P. 50-54.
Flora smear analysis is one of the most important diagnostic methods in gynecology. A smear is taken from the mucous membrane of the vagina, cervix or urethra. This analysis allows you to assess the state of the microflora of the genitourinary system and identify the presence of pathogenic microorganisms.
A smear test for flora in women is performed during a preventive examination by a gynecologist and in the presence of complaints from the genitourinary system. These include: painful sensations in the lower abdomen, itching, burning in the vagina, discharge, indicating a possible inflammatory process. It is also advisable to do this analysis at the end of a course of antibiotic therapy to prevent thrush and when planning pregnancy.
Why is this analysis prescribed?
Usually a vaginal smear is part of a woman's routine medical check-up. It is performed by a specialist during a gynecological examination. Biological material is also collected from the urethra and cervix.
This diagnosis allows you to detect possible problems with women's health, such as an inflammatory process or a disease caused by an infection. In medical terminology, such a study has another name - bacterioscopy.
A gynecological smear is taken if the following diseases are suspected:
- or vaginitis;
Specialists can prescribe a smear if the patient has the following complaints:
- Pain during sexual intercourse.
- Unpleasant-smelling copious discharge with discoloration.
A smear is taken when planning pregnancy and after antibiotic therapy. In addition, the smear allows you to monitor the effectiveness of therapy in the treatment of gynecological diseases.
Advantages of the method:
- Painless procedure.
- Simple rules for preparing for a smear test.
- Monitoring the effectiveness of treatment of female diseases.
- Possibility of identifying many diseases of the genitourinary system.
For preventive purposes, women periodically need to undergo this diagnosis. This will help prevent possible undesirable consequences.
Preparation for delivery
Some doctors say that this test does not require special preparation, however, this is not true. To ensure the reliability of the results, the patient is advised not to go to the toilet for 2-3 hours, since urine can wash away all pathogenic bacteria and infections, making it difficult for the attending physician to determine the causes of your pathological condition.
Douching, vaginal suppositories and antibacterial soap also contribute to unreliable indicators. Women must undergo this test after the end of menstruation, and in addition, all patients should refrain from any sexual intercourse 2 days before taking the biomaterial.
How is it surrendered?
The analysis is most often taken by a doctor when you come to him for a regular appointment at the clinic or when you simply go to a paid laboratory, where obstetricians and medical staff take biomaterial from you.
The gynecologist, obstetrician or any other medical professional lightly runs a special disposable stick-shaped spatula over three points - the vagina, urethra and cervical canal.
In men, a urologist or another doctor inserts a special disposable probe into the urethra, turns it around its axis several times and takes an analysis. It is believed that the examination does not cause pain, however, this does not exclude the carelessness of the doctor, as well as individual sensitivity or the presence of a particular disease, which can cause discomfort.
The meaning of the letters on the analysis form
Doctors do not use full names, but abbreviations - the first letters of each of the analysis parameters. To understand the normal microflora of the vagina, knowledge of the letter designations will be very helpful.
So, what are these letters:
- abbreviations of the areas from which the material is taken are designated by the letters V (vagina), C (cervical area of the cervix) and U (urethra or urinary canal);
- L - leukocytes, the value of which may not be the same in normal conditions and in pathology;
- Ep - epithelium or Pl.Ep - squamous epithelium;
- GN - gonococcus (the “culprit” of gonorrhea);
- Trich - Trichomonas (causative agents of trichomoniasis).
In the smear, mucus may be detected, indicating a normal internal environment (PH), beneficial Doderlein bacilli (or lactobacilli), the value of which is equal to 95% of all beneficial bacteria.
Some laboratories make it a rule to mark the content of a specific type of bacteria. For example, somewhere they use the “+” sign for this. It is put into 4 categories, where one plus is an insignificant content, and the maximum value (4 pluses) corresponds to their abundance.
If there is no flora in the smear, the abbreviation “abs” is indicated (Latin, this type of flora does not exist).
What doctors don't see with microscopy?
Using this analysis, the following conditions or diseases of the body cannot be determined:
1) Cancer of the uterus and cervix. To diagnose malignant degeneration of the endometrium, histological material is needed, and in large quantities. And they take it directly from the uterus during separate diagnostic curettage.
2) . To determine it, a smear is not needed and it does not matter what result it shows. It is necessary to take a blood test for hCG, undergo a gynecological examination by a doctor, or do an ultrasound of the uterus. It is possible to detect human chorionic gonadotropin in urine, but not in genital discharge!
3) CC and other pathologies (leukoplakia, koilocytosis, HPV infection, atypical cells, etc.) are diagnosed based on the results of a cytological examination. This analysis is taken directly from the cervix, from the transformation zone, using a certain 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:
- – must be present, but only in small quantities.
- (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.
- (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.
- Dederlein sticks - a healthy woman should have a lot of them. A small number of lactobacilli indicates a disturbed vaginal microflora.
The presence of Candida fungi, small rods, gram(-) cocci, Trichomonas, gonococci and other microorganisms in the analysis results indicates the presence of a disease and requires a more in-depth study and treatment.
Table for deciphering the normal smear in women (flora)
A breakdown of the results of a smear analysis for flora in women is presented in the table below:
Index | Normal values | ||
Vagina (V) | Cervical canal (C) | Urethra (U) | |
Leukocytes | 0-10 | 0-30 | 0-5 |
Epithelium | 5-10 | 5-10 | 5-10 |
Slime | Moderately | Moderately | |
Gonococci(Gn) | No | No | No |
Trichomonas | No | No | No |
Key cells | No | No | No |
Candida (yeast) | No | No | No |
Microflora | A large number of Gram+ rods (Dederlein rods) | No | No |
Degrees of purity based on flora smear
Depending on the results of the smear, there are 4 degrees of vaginal cleanliness. The degree of purity reflects the state of the vaginal microflora.
- 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.
- 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.
- 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.
- 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.