Gynecological smear: deciphering the analysis in women. Flora smear in women
Flora smear in women- laboratory research that determines the types of bacteria that are present in the vagina. This is the most common and simplest method for detecting inflammation and STDs (Sexually Transmitted Diseases).
The study is absolutely painless. It is done during a routine pelvic exam. The doctor takes the material from the walls of the vagina and cervix with a disposable spatula. The contents of the vagina (vaginal secretions) are applied to the glass. In the laboratory, the material is dyed to make the bacteria clearly visible.
Purpose of the study
- determine the state of the vaginal microflora;
- identify genital infections and their causative agent;
- determine the degree of the inflammatory process;
- assess the degree of cleanliness of the vagina, which is mandatory before further diagnostic studies and gynecological operations - cauterization of erosions, removal of polyps, curettage;
- assess the health status of pregnant women.
When does a gynecologist take a swab for flora?
- complaints of itching or vaginal discharge, other symptoms of inflammation;
- preventive examinations;
- control of the treatment carried out;
- taking hormonal drugs and immunosuppressants;
- microflora control against the background of long-term antibiotic use;
- pregnancy. It is carried out 3 times per pregnancy (upon registration, at the 30th and 36th week).
Normal vaginal microflora
The vagina of a healthy woman is not sterile. It contains many types of microorganisms, their totality is called microflora. Bacteria are constantly competing with each other for habitats on the walls of the vagina and for food.The most numerous are lactobacilli and bifidobacteria, which attach to the vaginal epithelium. They produce alcohols, peroxide, lactic and other acids that provide an acidic reaction of vaginal secretions. As well as lysozyme and other enzymes that inhibit the reproduction of other types of bacteria.
Microorganisms that make up the microflora of a healthy woman
| Microorganisms | CFU / ml |
| Lactobacillus or Doderlein sticks Lactobacillus spp | 10 7 -10 9 |
| Bifidobacterium Bifidobacterium spp. | 10 3 -10 7 |
| Clostridium Clostridium spp. | Up to 10 4 |
| Propionibacterium Propionibacterium spp. | Up to 10 4 |
| Mobiluncus Mobiluncus spp. | Up to 10 4 |
| Peptostreptococcus spp | 10 3 -10 4 |
| Corynebacterium Corynebacterium spp. | 10 4 -10 5 |
| Staphylococci Staphylococcus spp. | 10 3 -10 4 |
| Streptococci Streptococcus spp. | 10 4 -10 5 |
| Enterobacteria Enterobacteriaceae | 10 3 -10 4 |
| Bacteroides Bacteroides spp. | 10 3 -10 4 |
| Prevotella Prevotella spp. | Up to 10 4 |
| Porphyromonas Porphyromonas spp. | Up to 10 3 |
| Fusobacteria Fusobacterium spp. | Up to 10 3 |
| Veilonella Veilonella spp. | Up to 10 3 |
| Mycoplasma M.hominis | Up to 10 3 |
| Ureaplasma U.urealyticum | 10 3 |
| Candida - yeast-like mushrooms | 10 4 |
Abbreviation CFU / ml means - colony-forming units in 1 ml of nutrient medium. Each colony-forming unit is a microorganism from which a colony can form.
The number of bacteria is expressed in decimal logarithms, in order not to write numbers with big amount zeros.
In the description of the vaginal microflora, you can often find the names gram-positive or gram-negative bacteria... These terms mean that the first bacteria are stained according to the method developed by the microbiologist Gram, while the others do not change their color.
Gram-positive sticks in a smear which include lactobacilli are a good sign. Normally, they predominate in women of reproductive age. During menopause (menopause) and postmenopause, gram-negative bacteria come out on top.
Depending on the oxygen demand, bacteria are divided into
- aerobic- those that develop in the presence of oxygen;
- anaerobic- which do not need oxygen for their vital functions.
CFU / ml.
How is a smear done on the vaginal microflora?
Taking a smear takes place in the gynecologist's office. Also, a woman can undergo this study in a private laboratory. The procedure includes several stages.
- The woman is placed in a gynecological chair.
- Insertion of sterile speculum to gain access to the vaginal walls and cervix.
- Collecting material from back wall vagina. This procedure is completely painless. Unpleasant sensations can occur only when the spatula touches the inflamed area.
- Applying material to a glass slide. The vaginal secretion is spread by stroking movements over the defatted glass in the thinnest possible layer so that the cells are located in one row and do not close each other.
- Fixation of the smear is necessary if it is delivered to the laboratory after more than 3 hours. Processing allows to avoid deformation of cells during drying and makes it possible to preserve the drug.
- Staining the smear by the Gram method. Methylene blue is used as a dye. After staining, it is easier to establish the type of bacteria and determine the composition of the microflora.
- Evaluation of the result, which consists of 3 parts: counting leukocytes, species composition of microflora, assessment of the cleanliness of the vagina.
- the openings of the urethra and paraurethral passages (narrow channels parallel to the urethra);
- the walls of the vagina;
- cervical canal.
A smear on the flora from the vagina is an absolutely harmless procedure that is allowed, including for pregnant women. During the sampling of the material, the mucous membrane is not injured, therefore there are no restrictions after the procedure. It is allowed to take a bath, swim, have sex, etc.
How do you prepare for this smear?
It is necessary to take a smear on the flora no earlier than 3 days after the end of menstruation. Menstrual blood cells in a smear can skew the results. The period from the 10th to the 20th day of the cycle is considered optimal.The analysis result will be as reliable as possible if you adhere to the following rules.
- stop taking antibiotics and antifungal drugs in 14 days;
- in 2 days, stop the introduction of any vaginal forms of drugs - solutions, suppositories, tablets, tampons, ointments, creams;
- refrain from intercourse for 2-3 days;
- before the procedure, do not douche and wash inside the vagina.
What does a smear show on the vaginal microflora?
A smear on the vaginal microflora shows the presence of a number of diseases and pathological conditions.- Sexually transmitted infections (sexually transmitted infections)... They are evidenced by the presence in the smear of a significant number of ureaplasmas, mycoplasmas, gardenella, gonococci, Trichomonas and other pathogenic bacteria.
- Inflammation vagina(vaginitis, colpitis) or cervical canal(cervicitis and endocervicitis). Evidence of an inflammatory process is a large number of leukocytes in a smear.
- Dysbacteriosis of the vagina... Violation of the composition of microflora contributes to the development of diseases of the genital area. Dysbacteriosis is diagnosed when the number of lactobacilli decreases and other types of microorganisms begin to predominate.
- Candidiasis or thrush. Normally, single fungi of the genus Candida are permissible. With a fungal infection, their number increases sharply, pseudomycelium is found in the smear - threads of elongated cells and kidney cells sitting on them.
4 degrees of vaginal cleanliness
| Degree | Identified changes | What is he talking about |
| I | The environment is sour. Leukocytes - up to 10. Epithelial cells - 5-10. Most of the microorganisms are lactobacilli (Dederlein sticks). Other bacteria are isolated. Mucus is a small amount. | The ideal state of the vaginal microflora. It is extremely rare in women of childbearing age who are sexually active. |
| II | The medium is slightly acidic. Leukocytes - up to 10. Epithelial cells 5-10. Most of them are Dederlein sticks. Small amount of gram-positive cocci. Small amounts of mucus. | Normal condition. It occurs in most healthy women. |
| III | Wednesday is neutral. Leukocytes - over 10. Epithelial cells - over 10. Microorganisms in moderate to large numbers. Gram-negative and gram-negative rods and cocci are present. Single sticks of Dederlein. Key cells are present. Mucus is in moderation. | Vaginal inflammation - colpitis. Symptoms may occur: creamy vaginal discharge, itching, burning, discomfort during intercourse. In some women, this condition is asymptomatic. |
| IV | The medium is neutral or alkaline, pH over 4.5. Leukocytes - over 30 or the entire field of view. Epithelial cells are abundant. Microorganisms in massive numbers. Microflora is represented by various opportunistic and pathogenic microorganisms. Dederlein sticks may be missing. Much mucus. | Pronounced inflammatory process. Symptoms: Profuse vaginal discharge (white, yellowish, greenish), often with an unpleasant odor. Itching, burning, dryness, discomfort. Unpleasant sensations, pain during intercourse. |
What is the norm for a smear on the vaginal microflora?
In microscopy of a smear on flora, the norm is:- flat cells of the vaginal epithelium - up to 10 in the field of view;
- single leukocytes - up to 10 in the field of view;
- cells of the intermediate layer are single;
- "False key" cells - rarely;
- the total number of microorganisms is "moderate", sometimes "large";
- mucus - in small quantities;
- lactobacilli predominate among bacteria, other types of microorganisms are single, are rare.
- Large numbers of destroyed epithelial cells... This indicates cell lysis, which happens with abnormal growth of lactobacilli.
- Key cells... These are epithelial cells covered with various bacteria.
- Parabasal cells... Cells of the lower layers of the mucous membrane. Their appearance indicates significant inflammation or atrophy of the mucous membrane.
- "Massive" number of bacteria, except for lactobacilli.
- Yeast cells with pseudomycelium and blastopores (kidney cells). Their presence indicates thrush.
- Strict anaerobes - most of them are pathogens.
- Gonococcus - causative agents of gonorrhea.
- Trichomonas - causative agents of trichomoniasis.
- Atypical cells which are a sign of precancerous or cancerous changes .
What do leukocytes in a smear on vaginal flora say?
Leukocytes are white blood cells that are used to fight infection. They can go out through the vessel wall and move independently. Leukocytes have the ability to phagocytosis - they absorb bacteria and digest them. After the bacteria is digested, the leukocyte is destroyed. This releases substances that cause inflammation, manifested by edema and redness of the mucous membrane.Normally, the number of leukocytes in the vagina should not exceed 10. A large number of leukocytes speaks of inflammation. The higher the number of leukocytes, the more pronounced the inflammatory process.
Why is antibiotic susceptible to smear testing?
Antibiotic sensitivity or antibioticogram- finding out the sensitivity of bacteria to antibiotics. The study is carried out simultaneously with sowing a smear when pathogenic bacteria are found in the vagina that cause inflammation or genital infections. There are a large number of antibiotics, but not all of them are equally effective against different groups of bacteria (antibiotics do not affect viruses). It happens that after a course of antibiotics, the patient did not recover or the disease returned after a few days / weeks. This happened because antibiotics were prescribed for treatment, which had little effect on the causative agent of the disease.
In order for the treatment to be as effective as possible, it is necessary to determine which antibiotics:
- completely destroy the bacteria - the causative agent of the disease;
- stop the growth of the pathogen;
- do not affect the vital activity of this bacterium.
How is antibiotic susceptibility testing done?
After the bacteria that caused the disease have been identified, they are distributed in several tubes with culture media. A specific antibiotic is added to each tube. The tubes are placed in a thermostat, where optimal conditions for their reproduction.After cultivation (about 7 days), the growth of bacteria in test tubes is analyzed. Where bacteria are sensitive to antibiotics, colonies will not form. This drug is optimal for the treatment of the patient. In the test tube, where drugs are added, to which antibiotics are insensitive, the growth of bacteria is the most intense. Such medicines cannot be used to treat this disease.
What is smear culture?
Sowing smear or bacteriological culture (bacteriological culture) smear- This is a laboratory study in which the contents of the vagina are placed in a nutrient medium and create optimal conditions for the growth of bacteria.Research Objectives:
- identify the causative agent of genital infection;
- establish the degree of contamination - the number of bacteria in the vagina;
- control the state of microflora after long-term treatment with antibiotics, cytostatic drugs. It is carried out 7-10 days after discontinuation of the drug.
- all pregnant women upon registration;
- with inflammatory processes in the genitals;
- gram-negative diplococci were found in the smear - to confirm gonococcal infection (gonorrhea);
- with recurrent or chronic vulvovaginitis.
How is microbiological testing done?
The vaginal discharge is placed in culture media - solutions or jelly-like masses, which contain nutrients for bacteria. Test tubes and Petri dishes are placed in a thermostat for 3-5 days, where a temperature of about 37 degrees is constantly maintained, which is optimal for the reproduction of microorganisms.
After cultivation, the laboratory assistant evaluates the results. From each microorganism, in the process of division, a whole colony of bacteria grows. According to her outward appearance the laboratory assistant determines the type of pathogen. And by the number of colonies, one can judge the concentration of these microorganisms in the vagina. Further, the concentration is compared with normal values.
Those bacteria, the concentration of which exceeds 10 4 CFU / ml, are considered significant. At a given concentration, microorganisms can cause disease. If such a quantity of bacteria is detected, the result of the analysis is considered positive.
The conclusion issued by the laboratory indicates:
- view a microorganism that predominates in the smear;
- pathogenicity microorganism - the ability to cause disease:
- Pathogenic - the presence of which can only be caused by a disease.
- Conditionally pathogenic - bacteria that cause disease only with a decrease in immunity, with a significant increase in their number.
- concentration microorganism in the vagina. In a numerical indicator and in the form of a verbal characteristic: "poor", "moderate growth", "abundant growth."
| Degree | Features of the growth of bacteria | |
| Liquid nutrient medium | Dense nutrient medium | |
| I | Growth is very poor. | There is no bacterial growth. |
| II | Moderate growth | Up to 10 colonies of bacteria. |
| III | Abundant growth. | 10 to 100 colonies. |
| IV | Massive growth. | Over 100 colonies. |
Grade I is the norm. At the II degree, they speak of a violation of the vaginal microflora. III-IV degrees indicate a disease caused by this type of bacteria.
Microscopic examination of the smear allows you to identify useful and pathogenic microflora in the genital tract of a woman. Therefore, it is considered a very informative diagnostic method that identifies various diseases in gynecology from inflammatory processes to malignant tumors of the genitourinary system.
Usually, the gynecologist prescribes one of three smear studies for patients: microscopic, bacteriological, or cytological. What each gynecological smear means and what test results can be obtained will be described below.
Microscopic analysis of smear for microflora
Microscopy involves taking a smear from three areas: directly the vagina (V), the cervical canal (C) and the urinary canal (U). In some cases, the swab is taken from the rectum (R). How is content collected for research? The mucus is collected with a spatula or spatula. This is done carefully so as not to damage the mucous membrane in the marked areas. Before that, the doctor inserts a special mirror into the vagina, through which he sees the vaginal surfaces and the cervix. The taken mucus is distributed on a glass slide and sent for study.
Bacterioscopy of a smear includes staining the material with a dye, drying it and determining the species under a microscope. In this case, not only the species belonging of microorganisms (bacteria, fungi, etc.) is assessed, but also the quantitative indicators of each species. The analysis results are reflected on a paper form.
Decoding of individual indicators of microscopy
The decryption of the smear contains the following information:
- Epithelium. Its presence is the norm up to 15 units. in sight. Examination of the vagina reveals squamous epithelium, a smear from the cervical canal - columnar epithelium. Exceeding the value of the epithelium means inflammation in the organ. The interpretation of the parameter is possible only in conjunction with the rest of the analysis data.
- Leukocytes. For the vagina, the norm is about 5 units. in sight. For the vagina - 10 units. For the cervix - 30 units. in sight. Some content of leukocytes is necessary for the body to support and protect against adverse conditions. Exceeding the indicator means the presence of inflammation (colpitis, cervicitis or urethritis). The laboratory mark “cover the field of view” means that inflammation is at its peak, that is, in an acute form.
- Bacteria. In women of childbearing age, gram-positive bacilli with lactobacilli are normally observed in the vagina. The content of microorganisms in the cervical canal is lower than in the vagina. The microflora should not normally be present in the urinary canal. Many pathogenic microorganisms explain the development of vaginal dysbiosis or inflammation.
- Trichomonas, gonococcus and key cells in healthy women are not shown by the smear rate. If there are any, then we are talking about the existence of trichomoniasis, gonorrhea or gardnerellosis, respectively.
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Preparation for smear microscopy. Compliance with the basics of preparation for the delivery of a smear will help to obtain the most reliable test results. These are the rules:
- Eliminate antibiotics approximately 14 days before the smear test.
- Do not use local contraceptives, antibacterial and antiseptic drugs about 3 days before the analysis.
- The day before the smear, you can not live sexually.
- Three hours before visiting the gynecologist, you cannot wash and douche.
Taking a smear is considered a painless and safe procedure, which is recommended for all women every six months.
Cytomorphological smear analysis
This type of female smear also has other names - a smear for cytology or for atypical cells; Pap testing. The purpose of this analysis is to detect atypical cells indicating the development of a pathological condition in the cervix (dysplasia or malignant formation). Pap test allows you to diagnose papilloma, a viral infection directly related to dysplasia and cancer. Material for analysis is collected from the surface of the uterine cervix adjacent to the vagina, as well as from the cervical canal. The material applied to the glass is sent for study. According to the results of the study, smears are divided into 5 types:
The first is that the composition of the cells of the material (cytogram) has no peculiarities. In other words, the cervix is in perfect order. Second, the composition of the cells characterizes mild inflammation or dysplasia. Seeing a similar result, the doctor prescribes the treatment of inflammation and the subsequent passage of the Pap test. Third, there are signs of weak or severe dysplasia in the cells. With such analyzes, the doctor usually recommends an additional examination in the form of colposcopy, biopsy of the cervical tissue and histological examination of the collected material.
Type 4 - characterizes the precancerous state of the genital tract in women, suspicion of cancer. With this test result, the patient receives a referral for examination followed by treatment to a gynecological oncologist. Type 5 - malignant growth or cancerous growth. The woman receives further examination and specific treatment in the conditions of an oncological dispensary. Similar to the situation with a smear on microflora, the accuracy of cytology is determined by the literacy of a woman's preparation for sampling.
It is necessary to visit a gynecologist every six months. This will allow you to keep women's health under control and identify diseases in time. The simplest and most affordable research method in gynecology is taking a gynecological smear.
Deciphering such an analysis will allow the doctor to see changes in the woman's reproductive system that are not visible during an external examination.
- Taking a smear is an absolutely painless procedure and it only takes a couple of minutes in time. It does not pose a health hazard; it can even be performed on pregnant women.
When do you need to take a swab for flora?
Deciphering the analysis of a smear for flora can tell the gynecologist about the presence of genital infections, an inflammatory process, hormonal disorders in a woman's body.
A smear on flora (gynecological smear) must be performed if a woman presents complaints of the following nature:
- Discharge of an unusual color from the genital tract.
- Abdominal pain at rest or during intercourse.
- Itching and burning sensation in the genital area.
- The appearance of an unpleasant odor in the discharge.
Also, smears are taken during routine examinations.
Interpretation of smear results
With the help of letters, the doctor marks the place of taking the smear. Usually the letters of the Latin alphabet are used: V, C, U.
Swabs are taken from three points: the vagina (V-vagina), the cervix (C-cervix) and the urethra (U-uretra).
In deciphering a smear on the flora in women, you can find the strange word "cocci". Cocci are microorganisms that have a rounded shape. This is a group of opportunistic organisms that are constantly present in the body.
However, they must be in a certain amount. As soon as their number exceeds the permissible level, cocci can cause unpleasant symptoms due to inflammation. In gynecology, this condition is called nonspecific colpitis.
Cocci are divided into two groups: gram-positive and gram-negative. This division has an important diagnostic value in determining the pathogenicity of a microorganism that has settled in the vagina.
Coccal flora in a smear, gr. + Or gr. - cocci
smear on the flora of cocci sticks
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 stain in different colors, depending on the degree of their antibiotic resistance.
When coloring the preparations, a special dark blue or violet dye was used. The scientist noticed that some microbes are stained in blue color and others in pink, although the dye is the same.
After careful research, it was found that microbes colored pink or crimson are less sensitive to antibiotics. For their death to occur, considerable efforts must be made.
Microorganisms that stained well 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 simply explained: these bacteria had a thicker shell. The structure of the wall has a more complex structure than that of gram (+) cocci, which means that it is much more difficult for a dye or antibiotic to penetrate its layers.
This division is important for the 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 are capable of causing disease. The most common representatives of this group in gynecology are gonococci, the causative agents of gonorrhea.
What are Dederlein sticks?
An indispensable element of women's health is the rod flora in the vagina. Dederlein's rods are a generalized name that combines large and motionless gram-positive rods that provide the normal microflora of the female genital organs.
They can be found under the name lactobacillus or gram-positive bacilli.
Dederlein sticks play an important role in a woman's life:
- Contributes to the maintenance of an acidic environment in the vagina, which ensures careful selection of sperm during fertilization.
- As you know, sperm cells do not live long in an acidic environment. Therefore, the first to die are defective, weakened male cells, which allows only the strongest and most enduring to reach the goal.
- Suppress the development of pathogenic microorganisms by activating macrophages.
- Allocate hydrogen peroxide - helps to "keep clean" in the vagina.
In a smear of a healthy woman, Dederlein sticks should be in large quantities. A decrease in their number indicates possible problems with women's health.
What is Leptotrix in a smear?
Leptotrix belongs to opportunistic microorganisms. It is a gram (+) anaerobic bacillus that inhabits water bodies. Under the microscope, leptotrix looks like a hair - a long and thin rod.
It is believed that leptotrix is not sexually transmitted, and their presence in the smear is not a cause for concern, if no other abnormalities are found.
A feature of these bacteria is that they often accompany other pathogenic microorganisms - Trichomonas and Chlamydia. In this case, the doctor will prescribe medications to treat several pathogens at once.
If leptotrix is detected during pregnancy planning, treatment is mandatory. It was revealed that they can cause miscarriages, cause inflammation in the membranes, and infect a child.
smear analysis
Having received the test results, it is sometimes very difficult to understand the numbers and letters written by the doctor. In fact, everything is not so difficult. In order to understand if you have gynecological diseases, you need to know the indicators of the norm when decoding the analysis of a smear for flora. There are not many of them.
In smear analyzes in adult woman the indicators of the norm are as follows:
- Squamous epithelium (square epithelium) - normally its number should be within fifteen cells in the field of view. If the figure is higher, then this is evidence of inflammatory diseases. If less - a sign of hormonal disorders.
- Leukocytes (L) - These cells are allowed as they help fight infection. The normal number of leukocytes in the vagina and urethra is not more than ten, and in the cervical region - 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 in the results of the analysis of fungi of the genus Candida, small rods, gram (-) cocci, Trichomonas, gonococci and other microorganisms, indicates the presence of a disease and requires more in-depth research and treatment.
Table for decoding smear rates in women (flora)
| Index | Values of normal indicators | ||
| Vagina (V) | Cervical canal (C) | Urethra (U) | |
| Leukocytes | 0-10 | 0-30 | 0-5 |
| Epithelium | 5-10 | 5-10 | 5-10 |
| Slime | Moderately | Moderately | |
| Gonococcus (Gn) | No | No | No |
| Trichomonas | No | No | No |
| Key cells | No | No | No |
| Candida (yeast) | No | No | No |
| Microflora | Large amount of gram + sticks (Dederlein sticks) | No | No |
The degree of cleanliness of the vagina
Often the doctor will prescribe a referral for a smear analysis for cleanliness. With this method, the "degree of cleanliness" of the vagina is revealed. There are four of them. Only the first and second degrees are normal, the third and fourth degrees signal the presence of diseases of the genital tract.
1st degree - the 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 rods, mucus and squamous epithelial cells in small numbers.
2nd degree - The most common variant of the norm, in which leukocytes are within the normal range, mucus and epithelium in moderate quantities. A small number of cocci or Candida fungi appear, lactobacilli in large quantities.
Grade 3 - a large amount of mucus and epithelial cells is determined in the smear. There are few useful lactobacilli; instead, there is an increased number of Candida fungi and pathogenic microbes.
4 degree - there are so many leukocytes that the doctor describes them with the term "completely". A very large number of pathogens. Dederlein sticks are missing. Mucus and epithelium in large quantities.
The first and second degrees do not require treatment, and the last two degrees indicate an inflammatory process caused by one or another pathogen, and require urgent therapy.
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 in order to prevent diseases of the genital area, which can complicate childbirth or cause diseases in the newborn.
The indices of a smear of a pregnant woman differ from smears of a non-pregnant woman in the quantitative composition of the flora.
During the period of gestation, the number of Dederlein sticks increases tenfold. This is necessary to maintain an acidic environment, which has a devastating effect on pathogenic microbes, protecting the fetus from infection.
The number of epithelial cells also increases. During pregnancy, glycogen stores accumulate in them, which is used by lactobacilli as food.
Otherwise, there are no differences. The appearance of pathogenic microorganisms also requires treatment, only the more gentle methods of therapy are chosen (suppositories, tampons, ointments).
A smear from the genital organs (microscopic or bacterioscopic examination) is a study of biomaterial (discharge, scraping) from the genitals using a light microscope under various magnifications with or without preliminary staining of the material (native smear). Currently, the combined use of light microscopy and digital photography using various digital microscopes in conjunction with special computer programs, which significantly increases the research efficiency
When microscopic examination is used
The main indications for microscopic examination are the symptoms of genital infections, in most cases urethral and vaginal discharge. Microscopy is used to examine the secretion of the prostate gland in the diagnosis of prostatitis, urine sediment in the general analysis of urine, and also conduct cyto-morphological examination according to Papanicolaou. counting spermogram. A variant of microscopic examination is a study in a dark field.
Microscopic examination can be carried out not only from the discharge from the genitourinary organs, but also from the discharge and scraping from erosions and ulcers of the genital mucosa, from the rectum, the posterior wall of the pharynx and the conjunctiva of the eye.
How is microscopic examination performed?
To obtain a full-fledged smear, men are advised to refrain from urinating for several hours, women do not douche. The material is taken from the lesions with special instruments (for example, a Volkmann spoon). It is possible to collect material using microscope slides and a bacteriological loop. Usually, the material is taken from the urethra ( urethra), vagina, cervical canal, rectum, posterior pharyngeal wall, sometimes from the mucous membrane of the conjunctiva of the eye. More about the collection of material for research.
In the laboratory, the delivered smears of the test material, depending on the tasks, are stained with special dyes and microscoped under various magnifications of the microscope. The manifestations of the inflammatory reaction are noted: the presence of leukocytes, mucus, fibrin, when microorganisms are detected, the degree of contamination, the attitude to Gram staining and morphological features are noted. In particular, if gram-negative diplococci are found, especially with their intracellular location, an additional examination should be carried out for gonorrhea. The detection of protozoa (Trichomonas), mycelium or blastospores of the fungus in smears can serve as a basis for a positive result on the detection of these microorganisms in the test material
The main methods of staining smears from the genital organs
|
Painting method |
Characteristic |
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Native drug |
Study without the use of dyes. There are 2 more types - a study with the use of a saline solution (0.9% sodium chloride) and a 10% alkali solution (KOH). It is used to diagnose trichomoniasis, urogenital candidiasis, bacterial vaginosis, and study prostate secretions. |
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Aniline dyes |
The most commonly used solutions are methylene blue and brilliant green. It is used limitedly for the rapid diagnosis of gonococcal infection, trichomoniasis and determination of the leukocyte reaction |
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Gram stain * |
Depending on the chemical structure, bacteria have the ability to retain the crystal violet dye or discolor in alcohol. Gram-positive microbes are colored blue-violet, gram-negative - pink and red. When stained correctly, the preparation is orange-red in thin areas, lilac-violet in thick areas. |
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Romanovsky staining |
Coloring allows you to identify nuclear elements and volutin granules of a bacterial cell due to their affinity for basic paints. During microscopy, nuclear elements have a red-violet color, the cytoplasm is slightly pink. In younger cultures, the cytoplasm turns blue-violet. In bacterial rods, the nuclei are painted in a dark red-purple color, volutin - in cherry-red. It is limitedly used for the diagnosis of chlamydia and trichomoniasis. |
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Aniline dyes |
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Trichomonas vaginal |
Aniline dyes |
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Pseudomycelium |
Native drug |
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Dot-dash threads |
Native drug |
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Inclusions in epithelial cells |
Romanovsky staining |
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Crescent sticks |
Aniline dyes |
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Key cells |
Aniline dyes |
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Leukocytes * |
Leukocyte reaction with |
All painting methods |
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Coylocytosis |
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Giant epithelial cells |
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Atypical epithelial cells |
Precancerous and cancerous diseases of the cervix |
* Criteria for the number of leukocytes, indicating an inflammatory reaction depending on gender and the department of the genitourinary system (increase x 1000 immersion system)
Microscopic Leukocyte Response Interpretation
|
Material |
Men |
Women |
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Leukocytes |
Leukocytes |
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Vagina |
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Cervical canal |
Cervicitis |
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Prostate secret |
Prostatitis |
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* microscope magnification x 400, phase contrast microscopy
What is the normal smear in men
|
Index |
Normal (anterior urethra) |
|
leukocytes |
0-5 in sight |
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epithelium |
up to 5-10 in p.z. |
|
moderately |
|
|
gonococci |
not detected |
|
trichomonas |
not detected |
|
key cells |
not detected |
|
not detected |
|
|
microflora |
single cocci |
What is the normal smear in women
|
Index |
Vagina |
Cervical canal |
|
leukocytes |
0-10 in the field of view |
0-30 in the field of view |
|
epithelium |
depends on the phase of the menstrual cycle |
|
|
moderately |
||
|
gonococci |
not detected |
|
|
trichomonas |
not detected |
|
|
key cells |
not detected |
|
|
not detected |
||
|
microflora |
large numbers of gram-positive bacilli * |
absent |
* the number and ratio of detected microorganisms is estimated according to the classifications set out below
What is the degree of vaginal cleanliness
The degree of cleanliness of the vagina is an assessment of the amount and ratio of normal, opportunistic and pathogenic microflora and cellular elements of the vagina using light microscopy
Assessment of vaginal microflora according to F.M. Heurlien in 1910,
provides for differentiation into four degrees of "vaginal cleanliness" on the basis of microscopy of smears stained according to Gram. It is still used by many laboratories in Russia.
Heurlien Classic Vaginal Cleanliness Assessment, 1910
|
Purity |
|
| I | Gram-positive rods are found ("Dederlein's rods", they are also "vaginal" or "vaginal" rods) and a meager number of cells squamous epithelium |
| II | there is a small amount of foreign bacteria (cocci) with a predominance of gram-positive rods |
| III | coccal flora prevails, leukocytes are present in significant quantities |
| IV | Dederlein's sticks "are almost completely absent, there is a significant amount of" foreign "microflora, a very large number of leukocytes |
Modified classification of vaginal cleanliness by O. Jirovec, 1948
|
Purity |
Clinical and laboratory signs |
| I | Smears from healthy women containing epithelial cells and Dederlein's rods |
| II | Non-suppurative bacterial colpitis: detection of numerous non-homogenous bacteria without leukocytes. |
| III | Purulent bacterial colpitis: detection of numerous pyogenic microorganisms and leukocytes. |
| IV | Gonococcal infection: smears containing gonococci. |
| V | Trichomonas infection: a picture of trichomoniasis |
| VI | Thrush (Candida albicans infection): a picture of vaginal mycosis. |
Evaluation of the biocenosis of the vagina E.F. Kira, 1996
|
Biocenosis |
Signs |
Nosology |
|
Normocenosis |
Dominance of lactobacilli, absence of gram-negative microflora, spores, mycelium, pseudohyphae, leukocytes, single “pure” epithelial cells. |
Typical state of a normal vaginal biotope. |
|
Intermediate type |
Moderate or insignificant number of lactobacilli, the presence of gram-positive cocci, gram-negative rods. Leukocytes, macrophages, epithelial cells are found. |
It is often observed in healthy women, rarely accompanied by subjective complaints and clinical manifestations. |
|
Vaginal dysbiosis |
A small amount, but more often the complete absence of lactobacilli, abundant, polymorphic gram-negative and gram-positive bacillus and coccal microflora. The presence of "key cells", the number of leukocytes is variable, the absence or incompleteness of phagocytosis. The polymicrobial picture of the smear. |
Bacterial vaginosis. |
|
A large number of leukocytes, macrophages, epithelial cells, pronounced phagocytosis. |
Nonspecific vaginitis. |
|
|
When found: gonococci |
Gonorrhea |
Currently, in world medical practice, the term is used - lactobacillary grading (LBG), showing the population of the vagina with normal lactobacilli. Only 2 criteria are used - normal lactobacillary morphotypes and opportunistic coccal morphotypes.
Lactobacillary vaginal grade C A Spiegel 1993, Gilbert G G Donders 2000)
|
Degree |
Morphological picture |
| Predominantly lactobacillary morphotypes, with a small number of cocci | |
|
Lactobacillus morphotypes and a significant amount of coccal flora, but the number of lactobacilli exceeds the number of cocci |
|
|
Lactobacillus morphotypes and a significant amount of coccal flora, but the number of cocci exceeds the number of lactobacilli |
|
|
Presence of coccoid flora and absence of lactobacilli |
Where can I get more information
|
|
Experience of microbiological diagnostics of opportunistic vaginal infections (KMAX 2001) Full text |
> Microscopic (bacterioscopic) examination of a stained Gram smear in the diagnosis of infectious and inflammatory processes
This information cannot be used for self-medication!
Consultation with a specialist is imperative!
Microscopic examination (or bacterioscopy) is the study of microorganisms under a microscope. In order for the doctor to be able to distinguish some bacteria from others, a smear (biological material applied to a slide) is stained using a special technique - according to Gram.
Why is a bacterioscopic examination of smears carried out?
This method is inexpensive and fast, therefore it is widely used in the diagnosis of infectious and inflammatory processes of various localization. With the help of bacterioscopy, the doctor can detect bacteria, fungi, protozoa (for example, Trichomonas). At the same time, evaluating their shape, size and relation to dyes (microorganisms are gram-positive and gram-negative), a specialist can make an assumption about the type of pathogen.
In addition, when diagnosing inflammatory processes, the laboratory assistant assesses the number of leukocytes in the smear (the higher it is, the more pronounced the pathological process), the presence of epithelial cells, elements of dead cells, etc.
Thus, bacterioscopy allows the doctor to make a preliminary assessment of the presence of an infectious agent in the test material and determine the need for bacteriological inoculation.
What is being investigated using this method?
Most often this method is used in gynecology. With the help of it, smears taken from the vagina, cervix and urethra of a woman who have turned to a gynecologist if they have any complaints or just for a routine examination are examined.
In addition, microscopic examination of smears is used to examine the genitourinary tract in men. The test material for them is scrapings from the urethra, prostate secretions, and sperm.
Also, using bacterioscopy, you can study samples of other biomaterials: sputum and pleural fluid, discharge from wounds, eye discharge, pus from boils, carbuncles and other pathological formations in soft tissues and skin, smears from the throat, nose, ears, joint fluid.
Where and how can I get tested?
Preparation for the delivery of material for a bacterioscopic examination depends on the localization of the pathological process, therefore, in each specific case, the conditions for delivery are determined by the attending doctor and give appropriate recommendations.
The material for the preparation of the smear is taken by a doctor (gynecologist, urologist, ENT, ophthalmologist, surgeon, etc.) and, as a rule, he himself sends the samples obtained for examination to the bacteriological laboratory of a medical institution.
Disadvantages of the method
Bacterioscopy is an indicative diagnostic method that does not provide sufficient information to make a diagnosis. In addition, many pathogens are simply not visualized in smears, but this does not mean that they are not there. Therefore, in most cases, further examination of the patient is required, including bacteriological culture, as well as various specific tests. An exception is the use of bacterioscopy in gynecology - with the help of this study, the following diagnoses are confirmed: bacterial vaginosis, thrush, trichomoniasis, gonorrhea.
Interpretation of results
In the form of the result of a microscopic examination of a smear, the laboratory doctor indicates the following data: the presence and type of epithelial cells (this is important for gynecological smears), the presence of mucus and destroyed cells, the number of leukocytes in the field of view, the number, morphological types and relation to the dyes of the detected bacteria, fungi, protozoa. Further evaluation of the results is carried out by the attending physician.