Interpretation of smear for flora: epithelium, leukocytes, cocci, atypical cells

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

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

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

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

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

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

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

Epithelium, cervix(in p/zr)

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

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

Red blood cells, cervix(in p/zr)

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

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

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

Microflora(quantity)

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

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

Leukocytes, vagina(in p/zr)

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

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

Epithelium, vagina(in p/zr)

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

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

Red blood cells, vagina(in p/zr)

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

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

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

Microflora(quantity)

Bacteria that can be seen in a vaginal smear.

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

"Key" cells(quantity)

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

Fungal spores, fungal mycelium

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

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

Slime

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

Trichomonas

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

Diplococcus(gonococci, Gram-diplococci)

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

In the vast majority of cases, leukocytes in a smear are a sign of an inflammatory process in the organs of the urogenital tract, both female and male. However, a rare man, especially in at a young age can “boast” that a smear was taken from him if everything is in order with the genitourinary system. For men, smears are not mandatory tests during medical examination. Another thing is women. Probably, there are no such people who are not subjected to such manipulations at least once a year. And this is in the absence of pathology, but if there are problems, then smears are taken as needed.

Norm and pathology

Normally, material from the male urethra is not abundant. Single leukocytes, transitional epithelium in a smear, single rods - that’s all that can provide us healthy man.The appearance of a large number of leukocytes in a smear of the stronger sex is usually accompanied by the presence of the culprits of inflammation(, yeast-like fungi of the genus, etc.), which is treated, and then analyzed again to ensure the success of the measures taken.

As for women, then increased amount leukocytes is observed before menstruation and is considered an absolutely natural phenomenon. In addition, the increased content itself (the norm is up to 30 cells in the field of view) is not considered a reliable indicator; the absence of leukocytes is considered evidence of a normal leukocyte level. morphological characteristics these cells. They are “quiet”, not destroyed (the nuclei are preserved), there are no signs of phagocytosis. In addition, sometimes the reason for the diagnostician’s confusion may be incorrectly taken material. An example is a “thick” smear, which is practically invisible due to the fact that the entire field is dotted with clusters of overlapping cells (including leukocytes). Without the risk of making a mistake, in such cases the woman is offered to take the test again.

Table: normal smear results for women

V - material from the vagina, C - cervical canal (cervix), U - urethra

Flora and cytology - what is their difference?

If in men the analysis is taken only from the urethra, then in women there are more objects of study: urethra, vagina, cervix, cervical canal. True, sometimes they take an aspirate from the uterine cavity and also make smears, but this is considered biopsy material, which is reviewed by a cytologist. He also makes a conclusion. Aspirates are not taken during routine examinations; this analysis is used exclusively with diagnostic purpose to detect cancer and precancerous diseases of the main reproductive organ in women. In addition, if the aspirate is filled with formaldehyde, and then applied to glass and stained, you will get a histological preparation, which is considered the last resort in the diagnosis of malignant neoplasms.

Probably many have heard the expressions: “smear for flora”, “smear for cytology”. What does all of this mean? How are they similar and how are they different?

The fact is that in a smear on the flora at high magnification with immersion, the doctor can count the cells, detect trichomonas, yeast, diplococci, gardnerella and other microorganisms that represent the rich biocenosis of the female reproductive system. But he will not be able to determine morphological changes in the epithelium, since these are different areas of laboratory diagnostics, where cytology occupies a separate niche. The study of the cellular composition of some material requires, in addition to certain knowledge, also special training. The study of pathological changes in the cell and nucleus gives very little theoretically; here, as they say, a trained eye is needed.

The doctor deciphers the analysis in both cases (flora and cytology); we only have to become slightly familiar with some concepts so that, when faced with a similar problem, we do not get scared or panic.

Cytological examination

The tasks and functions of cytology are much wider, and therefore its capabilities are also wider. The doctor examining the material focuses on the condition of the epithelial cells in order to identify pathological processes (inflammation, dysplasia, malignant neoplasms) and at the same time notes the flora. Most often, the vaginal portion of the cervix, represented by multilayered (four-layer) squamous epithelium (MPE) and the cervical canal, is subject to examination. With a correctly taken smear from the cervical canal, the normal cytological preparation clearly shows the prismatic (cylindrical) epithelium, single leukocytes and depleted microflora that could have come from underlying departments(from the vagina, for example).

It should be noted that the cytological preparation is more informative, since the staining method (Romanovsky-Giemsa, Pappenheim or Papanicolaou) gives a clearer picture. Cells are first viewed at low magnification to evaluate general state preparation, and then on a large one (with immersion), in order to consider not only the epithelium itself, but also changes in the nucleus characteristic of a particular disease. In a word, the cytologist sees the flora, inflammation, and in most cases its cause and the changes that this inflammatory process entailed. As well as indicative signs of infections that present particular difficulties in diagnosis, pre-tumor and tumor states of the epithelium.

Video: about a smear for oncocytology

Indirect signs of some STIs in cytology

As for the smear for STIs, it is advisable to examine it as a cytological preparation. A smear taken on the flora and stained with methylene blue is the most important, accessible and cheap, and therefore the most common diagnostic method in gynecology. However, unfortunately, it does not provide the necessary completeness of the picture for the diagnostic search for STDs and their consequences.

In addition to all possible inhabitants, which, when infected or disrupted biocenosis, are visible in a smear on the flora (Trichomonas, yeast, leptothrix), in the studied material (cytology) one can find indirect signs the presence of microorganisms that are very difficult to identify using microscopic methods:

• The appearance of giant multinucleated MPE cells, sometimes quite bizarre in shape, often with signs of parakeratosis and hyperkeratosis (keratinization), indicates a possible lesion;
• Cells in the form of an “owl’s eye” with coarse-grained cytoplasm are characteristic of;
• When you can detect koilocytic atypia (MPE cells with large nuclei and a clearing zone around the nucleus);
• Provacek bodies in the cells of metaplastic epithelium, which are characteristic of and play a role in screening studies, are also indicative.

Of course, make a diagnosis of herpetic, cytomegalovirus or papillomavirus infection when cytological analysis it is impossible, but it can be assumed, and this is already the basis for further, more in-depth examination in a specific direction (, etc.). Thus, cytology allows you to narrow the diagnostic search, avoid unnecessary tests, save time, and quickly begin treatment measures.

How to properly prepare for the analysis?

Since the simplest and most accessible method for identifying inflammatory processes of the urogenital tract, both in men and women, is a smear on the flora, it is necessary to pay more attention to it and teach the reader to understand a little about the entries entered in the form.

However, before you visit your doctor, Patients should know some simple rules:

1. A couple of days before the test, it is necessary to exclude not only sexual contact (sometimes you can see sperm in a woman’s smear), but also any interventions such as douching, medications local use (suppositories, creams, tablets);
2. You should not go for such a study during menstruation, because menstrual blood will interfere with viewing the drug, where the doctor will mainly see it;
3. On the day of the examination, you need to calculate the time so that you urinate for the last time 2-3 hours before, since urine can wash away all the “information”;
4. 7-10 days before the test, stop taking pharmaceuticals, especially antibacterial action or take a smear only a week after the end of treatment;
5. Another rule that women often ignore: do not use intimate hygiene products. Of course, it is very difficult to abstain from such procedures altogether, as experts recommend, but you can at least limit yourself to clean warm water. Men perform the last toileting of the external genitalia in the evening before visiting the doctor.

After following these tips, the person goes to an appointment, where they will take a smear, paint and look under a microscope. The doctor will do the decoding, and the patient will receive a conclusion, and he will probably be interested to know what all these numbers and words mean.

Video: preparing for a smear

What can be seen in a urethral smear in men?

The reader probably guessed that taking a test from men is unlikely to leave pleasant memories, because the object of study is not so accessible to them, so there will indeed be discomfort, which may not leave a person for several more hours. Sometimes, to avoid this, the doctor prescribes a prostate massage to the patient, which is performed several days before the procedure per rectum, that is, through the rectum.

However, if the burning sensation and soreness in the penis continues to remind itself for several days, and these phenomena are also supplemented by similar ones, a trip to the doctor is inevitable. But if everything went well, then perhaps men will be reassured by the fact that in their smear taken from the urethra, everything looks much simpler, unless, of course, normal analysis:

• The norm of leukocytes is up to 5 cells in the field of view;
• The flora consists of single rods;
• The general background dilutes the urethral epithelium (mainly transitional) - approximately 5-7 (up to 10) cells;
• A small amount of mucus that does not play any role;
• Sometimes a smear may contain opportunistic flora in single specimens (streptococci, staphylococci, enterococci), but in order to differentiate it, it is necessary to stain the smear according to Gram.

In the case of an inflammatory process, the smear changes:

1. A large number of leukocytes appear in the smear, sometimes not countable;
2. Coccal or cocco-bacillary flora displaces rod flora;
3. The drug contains microbes that cause inflammation (Trichomonas, gonococci, yeast, etc.);
4. It is hardly possible to see microorganisms such as chlamydia, urea and mycoplasma under a microscope, just as it is difficult to distinguish pathogenic diplococci that cause gonorrhea from pairwise enterococci or a chain of Enterococcus faecalis (enterococci too) from streptococci, therefore in such cases, to clarify the species The study of the pathogen is supplemented by the cultural method or the almost universal and popular nowadays PCR (polymerase chain reaction);
5. With rare exceptions, E. coli can be detected in a man's smear (a flagrant violation of hygiene rules!), which is beneficial in the intestines, but causes cystitis when it enters the man's urethra. Additional laboratory research methods are also needed to differentiate it.

The same is done with female smears, since the diplococci found may not be Neisseria and may not cause gonorrhea. By the way, E. coli (Escherichia coli), enterococcus (Enterococcus faecalis), staphylococci with streptococci and other microorganisms in female smears are found much more often, due to the structure of the female genital organs.

Ecosystem of the female urogenital tract

Leukocytes in a smear taken in gynecology, whether for flora or cytology, are not the only cells present in the preparation. In addition, they act only as a consequence or reaction to events occurring in the ecosystem (hormonal fluctuations, inflammation). For example, their increase in different phases of the cycle is due to hormonal influence, therefore, when collecting material, the date of the last menstruation is indicated on the referral form.

A diagnostic criterion for the inflammatory process is considered not only a large number of Le, “running” to the site of “military actions,” but also the state of their nuclei. When leukocytes react, they try to absorb the “enemy”, phagocytose, but at the same time begin to destroy themselves. The destroyed cells are called neutrophilic leukocytes, but this phenomenon is not indicated in the analysis transcript. A large number of neutrophilic leukocytes, together with abundant cocco-bacillary or coccal flora, serves as the basis for confirming the presence of an inflammatory process.

The ecosystem of the female genital organs includes microorganisms that occupy certain niches, which are: the epithelium of the vagina, cervix, cervical canal, rich in endocervical glands. These anatomical formations provide conditions for the vital activity of certain microorganisms. Some of the inhabitants are obligate, while others come from outside due to certain circumstances and cause various inflammatory reactions of the epithelium.

In addition, the balance in the ecosystem can be disrupted by various factors that negatively affect a woman’s body (both internal and external), which lead to the fact that microbes living in small numbers begin to displace the natural inhabitants, representing the rod flora, and occupy the dominant position. position. An example of this is the colonization of the vaginal environment by Gardnerella, which for a number of reasons displaces lactobacilli (Doderlein bacilli). The result of such a “war” is widely known.

Normal in a gynecological smear

The microscopic creatures that live in the genital tract of a woman are diverse, but norms still exist, although sometimes their boundaries are very difficult to determine, but we will still try to do this. Thus, in a smear taken in gynecology you can find:

• Leukocytes, the norm of which in the urethra is up to 10 cells in the field of view, in the cervix and its canal - up to 30 cells. During pregnancy, these indicators change upward;
• The type of epithelium in the smear depends on the location of the material collection: the urethra, neck, and vagina are lined with stratified squamous epithelium (MSE), which we will obtain in the preparation. A smear from the cervical canal will be represented by cylindrical (prismatic) epithelium. The number of cells changes in different phases of the cycle, but in general, it is generally accepted that, under normal conditions, their content should not exceed 10 units. However, all this is very conditional, since for accurate diagnosis it is necessary to take into account morphological changes in cellular structures(nucleus, cytoplasm, presence of “naked nuclei”), that is, carry out cytological analysis;
• Mucus in the preparation is considered an obligatory, but moderate, component, because the glands of the cervical canal and vagina secrete it. Mucus looks interesting during the ovulatory phase of the menstrual cycle; it crystallizes and forms patterns similar to the leaves of a plant, which are called the “fern symptom” (cytology);
• A normal smear is usually represented by rod flora (lactobacillus) and single cocci.

Opportunistic flora is not always the norm

In addition to lactobacilli - the main representatives normal microflora genital tract, which has the important function of “self-cleaning the vaginal environment,” other opportunistic microorganisms can be found in small quantities in the smear:

All these representatives of microflora can live without bothering anyone, or cause inflammation under certain conditions. By the way, even lactobacilli in excess quantities and in an abundant bacterial flora can provoke an inflammatory process - lactobacillosis, manifested by itching, burning, and discharge. The disease, of course, is not fatal, but very painful.

Pathogenic "guests"

The presence of pathogenic microorganisms, transmitted mainly through sexual contact, almost always leads to trouble. Local inflammation caused by the pathogen can spread to other organs and systems and (often) become chronic if not treated in time.

This phenomenon is especially dangerous during pregnancy, since many pathogens can have very negative impact on the fetus, so a bad smear during pregnancy is a guide to action, and immediate action. What microorganisms can threaten the human reproductive system through sexual transmission? We probably won’t surprise anyone by naming them, but once again it won’t hurt to remind you of the danger posed by microscopic creatures.

gonococcus - the causative agent of gonorrhea

Thus, pathogenic microflora of the genital tract include:

What is the degree of purity?

A smear to determine the degree of vaginal cleanliness is taken like a regular smear for flora, but is assessed somewhat differently. In gynecology, there is IV degree of purity:

I degree– a rather rare phenomenon, the smear is clean, only rod flora, single leukocytes and cells squamous epithelium in optimal quantities;

II degree– single cocci may “slip” among the rods or other non-pathogenic microorganisms may also be mixed in single copies, this degree is the most common among gynecologically healthy women;

table: standards for assessing vaginal cleanliness

III degree– it is characterized by opportunistic flora and yeast-like fungi that tend to actively reproduce. This may indicate the development of an inflammatory reaction to the presence of an excess amount of opportunistic microorganisms. This analysis requires additional examination of the woman;

IV degree– signs of an obvious inflammatory process: abundant coccal or cocco-bacillary (mixed) flora, possible presence of Trichomonas, gonococci or other pathogenic microorganisms. In such cases, additional laboratory tests (bacteriological, PCR, etc.) are prescribed to search for the pathogen and further treatment.

A smear on the flora, although considered a simple method, has great potential. The first step in the laboratory diagnosis of diseases of the urogenital tract, sometimes, immediately solves the problem and allows you to immediately begin therapeutic measures, the quality of which will subsequently be controlled by the smear itself, so avoiding such an accessible procedure is not recommended. It doesn’t require a lot of expenses, and you won’t have to wait long for an answer.

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In gynecological practice, this diagnostic method, such as a smear, is used very widely and is used often. This is one of the main standard procedures that helps assess the condition of the reproductive system organs in women.

Of course, absolutely all pathologies cannot be identified using this diagnostic method, but at least many of them can be suspected based on the smear results. That is why analysis is paramount: it allows you to determine the course of further diagnostics, select deeper and informative methods research.

What do you pay attention to when deciphering an analysis?

Smear analysis allows you to evaluate the following indicators: leukocytes, squamous epithelial cells, key cells, mucus in the biomaterial, as well as the content of normal, pathogenic and opportunistic flora. The last category includes yeast of the genus Candida. Among pathogenic microorganisms, trichomonas and gonococci can be detected using a flora smear.

A very important diagnostic indicator is the leukocyte count. These cells of the immune system protect the body from foreign agents, whether microorganisms or destroyed or altered structural elements.

It is leukocytes or white blood cells that rush to the pathological focus of inflammation in the body, wherever it is. And if pathology develops in the organs of the reproductive system, these cells will go there.

In women, leukocytes are always present in a smear for flora, and their norm is a rather arbitrary concept. The point is that in different areas genitourinary system their valid value varies. Most white blood cells are in the cervical area; their lowest content is normally observed in the urethra.

However, to diagnose inflammatory processes, it is important to evaluate not so much the number of leukocytes as their morphology. This is due to the fact that white blood cells, which have fulfilled their function of “cleansing” the body of pathogens, are destroyed. Such leukocytes are called neutrophils.

• Accordingly, the more of them in the smear, the stronger the inflammatory reaction.

In addition, it is important to take into account the fact that the concentration of white blood cells during the menstrual cycle changes under the influence of sex hormones, so if the leukocytes in the smear are slightly elevated, this is not necessarily a sign of a serious pathology.

In any case, the content of these cells should only be assessed in conjunction with other diagnostic criteria: the composition of normal flora and opportunistic microorganisms, the presence or absence of pathogenic bacteria, the number of epithelial and key cells.

As noted above, diagnostic material for a smear on the flora is collected from three points - the cervix, urethra and vagina.

And in each smear obtained, similar indicators are assessed, but the norms of some of them differ depending on the area of ​​localization. Below is a table explaining the normal content of leukocytes, normal and pathogenic flora, cellular elements and mucus in a smear in women.

Diagnostic criterion	Normal indicators
	Vagina (V)	Cervix (C)	Urethra (U)
Leukocytes (Le)	0-10	0-30	0-5
Slime	moderately		—
Epithelial cells	5-10
Key cells	—	—	—
Microflora	Gram-positive rods (bifido- and lactobacilli) ++++	—	—
Yeast (Candida)	—	—	—
Trichomonas (Trich)	—	—	—
Gonococci (Gn)	—	—	—

A smear that fully corresponds to the normal parameters is a rather rare phenomenon. However, minor deviations from the norm are allowed when it comes to the vagina. The urethra and cervix, if there are no pathologies, must be sterile - there should be no microflora there. Regarding the vagina, the situation is ambiguous.

Depending on the content of various microorganisms, there are 4 degrees of purity.

An ideal smear, free of leukocytes and pathogenic flora, corresponds to the first. However, most women cannot boast of such results. Often, individual leukocytes are found in the vaginal discharge within the normal range (up to 10 pcs.), an insignificant content of epithelial cells and opportunistic bacteria. This picture is not characterized as pathological, and the smear belongs to the second degree of purity.

If gram-variable coccal flora, gram-negative bacilli or yeast cells are detected in the vaginal discharge against the background of a decrease in the concentration of lactobacilli and bifidobacteria (Doderlein bacilli), this is a reason for further diagnosis. Such a smear is classified as the third degree of purity. White blood cells in it exceed the norm, and also contain a lot of mucus.

In a smear of the fourth degree of purity, there are very few or no Doderlein rods (normal flora), leukocytes cover the entire field of view, the content of mucus and epithelial cells is increased. In addition, pathogenic microorganisms are found in large numbers. This condition requires prompt treatment.

Causes of elevated white blood cells in a smear

If a woman’s smear has elevated leukocytes, the reasons for this are related to inflammatory processes. The greater the concentration of these cells, the more pronounced the process. However, this indicator must be assessed in conjunction with other diagnostic aspects.

For example, an increase in mucus content is observed with the development of infections. This is how the body strives to “cleanse itself” of pathogens. An increase in the number of epithelial cells, as well as leukocytes, warns of inflammation.

According to some laboratories, the content of these elements up to 10 in the field of view is allowed, but this indicator varies depending on the phase of the menstrual cycle and its values ​​​​should not be interpreted without regard to other diagnostic signs.

Key cells are epithelial cells dotted with Gardnerella bacteria. This is the so-called “bacterial sand”. If such cells are detected in a smear, there is a high probability of developing bacterial vaginosis (gardnerellosis).

The detection of a large number of candida in a smear against the background of suppression of normal flora is a sign of thrush. This is due to the fact that when the concentration of Doderlein rods, which produce lactic acid, decreases, the pH of the vagina increases.

This condition leads to the active growth of opportunistic flora, including candida. In an acidic environment, these microorganisms cannot reproduce, and thus bifidobacteria and lactobacilli inhibit the process of colonization of the vagina.

Gonococci and Trichomonas are pathogenic microorganisms. Under no circumstances should they be in the smear. The detection of these bacteria signals the development of gonorrhea or trichomoniasis.

Conception triggers a cascade of processes in a woman’s body, and in order for them all to proceed smoothly, the balanced functioning of the endocrine organs that produce hormones is important. Changing their balance causes powerful changes in the functioning of organs and systems.

Thus, sex hormones - progesterone and estrogens - stimulate the work of squamous epithelial cells. They begin to actively synthesize glycogen, which supports the reproduction of normal flora. By destroying this connection, Doderlein's bacilli produce large amounts of lactic acid, which acidifies the environment, and thereby provide protection against infections.

However, given the physiological decrease in immunity during pregnancy, this measure is often not enough. Many expectant mothers, when the balance of hormones changes, begin to suffer from thrush or other pathologies caused by opportunistic microorganisms.

Against this background, an increased content of leukocytes is noted in the smear. Often the concentration of such cells in the vagina of pregnant women exceeds the norm - up to 10 pieces. in one field of view.

• If their content is no more than 15-20, and the expectant mother does not experience any signs of pathology, and the rest of the smear indicators are normal, there is no need to worry.

It is important to note that the concentration of leukocytes in the urethra and cervix should not change. The norms for these indicators are the same as for non-pregnant women. Elevated white blood cells in the urethra are a sign of inflammation. This condition requires diagnosis and treatment.

During pregnancy, the leukocyte count should be monitored especially carefully, as it warns of the manifestation of pathologies chronic course. It is better for the expectant mother to undergo an examination once again.

Proper preparation for a smear test

Like most diagnostic tests in medicine, a flora smear requires preparation. When going to the gynecologist, a woman should remember that the test result will be reliable only if the following recommendations are followed:

• maintain sexual rest for at least 2 days before donating the biomaterial;
• stop using lubricants, vaginal suppositories, creams on the eve of the study;
• do not wash your face using gels or other intimate hygiene products;
• refrain from taking a test after a course of antibiotics (at least 10 days);
• do not urinate less than 2 hours before visiting a gynecologist;
• Do not get tested during menstruation.

Intimacy, by any means local application, antibiotics distort data about the real state of the microbial biocenosis of the genitourinary system in a woman.

During urination, diagnostically significant objects of study are washed away: cellular elements, microorganisms, which also changes the overall picture. Menstruation makes it more difficult to obtain material for diagnosis - it will be “contaminated” with a large number of red blood cells.

Indications for taking a smear

A smear in women involves taking biomaterial not only from the vaginal mucosa. Samples for analysis are also taken from urethra, cervix.

After the start of sexual activity, every woman should undergo this diagnostic procedure regularly: at least once a year. In addition to preventive examinations, a smear should also be taken during pregnancy. If there are no alarming symptoms, to the expectant mother you will have to go through this procedure twice: at the very beginning of pregnancy when registering and in the third trimester, after 30 weeks.

However, a good reason to undergo a smear test is if any woman, either pregnant or not, has the following symptoms:

• change in color and consistency of discharge;
• the appearance of discomfort when urinating;
• itching in the groin area;
• unpleasant odor of discharge;
• burning sensation in the vagina;
• abdominal pain at rest or during intimacy.

In addition, it should be remembered that prolonged treatment with antibiotics can negatively affect the vaginal microflora: cause the death of beneficial bacteria, which will be replaced by opportunistic inhabitants. Against this background, candidiasis often develops, bacterial vaginosis and they can be diagnosed using a smear on the flora. That is why it is advisable to take such an analysis after completing a course of antibiotic therapy.

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 preventive examination a gynecologist and if there are 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.

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Rules for taking a smear for flora

In order for the results to be more informative and reliable, a woman should comply with several conditions 1-2 days before taking the test. Firstly, do not have sexual intercourse, do not use lubricants, suppositories and other vaginal products, do not douche or take a bath, and secondly, choose a time when there is no menstrual bleeding.

Thirdly, on the day of visiting the gynecologist, it is not advisable to wash the external genitalia using detergents, with the exception of soap. It is not recommended to urinate two to three hours before taking a smear. A smear of the woman’s flora is taken with a sterile cotton swab or a special spatula from three places - from the mucous membrane of the vagina, the cervical canal of the cervix and the opening of the urethra.

The smear procedure itself does not cause pain, allows you to get an idea of ​​the state of women's health and, as a rule, is included in medical procedures gynecologist. In case of treatment, this analysis becomes an integral part of monitoring the effectiveness of therapy.

Flora smear: norm and deviations from it

Normally, in a healthy woman, 95% of lactobacilli should be detected in a smear. These microorganisms synthesize lactic acid, with the help of which the necessary acidity is maintained and the genitals are protected from the penetration of infectious pathogens.

In pregnant women, the number of lactobacilli is very often reduced, which leads to a weakening of the body's natural defenses and greater susceptibility to sexually transmitted infections. That is why it is important to do a smear on the flora during pregnancy.

In addition to lactobacilli, normal microflora may contain microorganisms such as gardnerella and candida, but their number should be small. With a decrease in immune defense due to fatigue, emotional stress, pregnancy or various diseases, gardnerella and candida begin to actively multiply, which leads to vaginal dysbiosis, the development of gardenerellosis and candidiasis.

What does a smear on the flora show: decoding

To simplify work and save time, medical workers use letters that imply one or another analysis indicator. This is worth dwelling on in more detail.

The letters V, C and U are the locations from which the smear is taken. V – from lat. “vagina” or vagina, C – from “cervix” – cervical canal of the cervix, U – “uretra” – urethra.

L is for “leukocytes”. They occur both normally and in pathology. With pathology, their number increases significantly.
Ep is “epithelium”. In some cases, you can find “Pl.Ep.”, which means “squamous epithelium.”
Gn is the causative agent of gonorrhea (microorganism gonococcus).
Trich is the causative agent of trichomoniasis (microorganism Trichomonas).

There may also be mucus in the smear, which indicates a normal vaginal pH.

In many laboratories, the amount of a particular flora is marked with a “+” sign.

“+” – insignificant amount;
“++” – moderate amount;
“+++” – increased quantity;
“++++” – copious amount.

If any microorganism is not detected in the smear, they put “abs” (from the Latin “absence”)

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 disorder acid-base balance microflora in the vagina and its shift in 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).

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?

For detailed description microbiologists, in addition to indicating the shape, size and other characteristics of bacteria, 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.

Flora smear during pregnancy

During pregnancy, a woman produces a large amount of the hormone progesterone, which helps to increase the number of lactobacilli (sometimes 10 times). Thus, nature protects the child from various infections while he is in the womb. Therefore, it is extremely important to do a smear on the flora before pregnancy and determine the degree of cleanliness of the vagina.

A smear test is taken from a pregnant woman upon registration, and then at 30 and 38 weeks in order to monitor the condition of the vaginal microflora. To assess this indicator, the term “degree of vaginal cleanliness” is used. A woman should know this degree. She should also ensure that the required level is maintained throughout the pregnancy.

What are the different levels of vaginal cleanliness?

1 degree of purity indicates that the woman is absolutely healthy. In the smear, the microflora is represented by lactobacilli by 95% or more. Single leukocytes and epithelial cells are detected.
2nd degree of purity corresponds to the same picture as with 1st degree, however, opportunistic microorganisms may be present in small quantities in the smear.
3 purity indicates that the number of opportunistic microorganisms is greater than Doderlein bacilli.
4 degree of purity means that the smear contains a lot of epithelium, leukocytes and bacterial flora. There are few or no rods at all.

Each degree of purity is characterized by a different vaginal pH. At levels 1 and 2 the pH is acidic, and at levels 3 and 4 the pH becomes slightly alkaline and alkaline.

Flora smear analysis: interpretation of results

What do the results indicate? Detection of certain elements in a smear allows not only to identify possible diseases, but helps to determine further tactics for diagnosing and treating a woman.

An increase in the number of epithelium and leukocytes is a sign of acute or chronic inflammation. Mucus is normally present only in the vagina; finding it in the urethra indicates possible inflammation lower parts of the urinary system.

Coccal flora should normally be absent in the urethra, and only a small amount of these microorganisms is allowed in the vagina. An increase in the number of cocci causes a decrease in the rod flora and a change in the degree of purity, which indicates a violation of the vaginal biocenosis and the presence of an inflammatory process.

If gonococcus is detected in the smear, it means that the patient has gonorrhea. Trichomonas and gardnerella indicate the presence of trichomoniasis and gardnerellosis. An increase in fungi of the genus Candida indicates dysbiosis and a change in the degree of purity. This is usually accompanied by a decrease in the number of Doderlein rods.

To summarize, we can confidently say that flora smear analysis is one of the most important indicators functioning of the immune system, as well as a marker of dysbiosis and chronic infections genitourinary system.

At every visit to the gynecologist during the examination, samples must be taken from the urogenital tract, regardless of whether the woman has complaints or not. A smear on the flora shows not only beneficial, opportunistic and pathogenic bacteria, but also leukocytes.

Often, elevated white blood cells in a smear in women indicate some kind of problem in the body, which requires finding out the cause of this condition, and, of course, treatment. It is important to remember that no amount of self-medication will help cope with the problem, and sometimes can lead to negative consequences.

Briefly about leukocytes

Leukocytes are white blood cells that protect the body from all types of harmful agents (bacteria, viruses, etc.). That is, the main function of leukocytes is to protect the body, as specific, for example, from certain type microorganisms, both nonspecific and general.

The concentration of leukocytes increases in areas of inflammation, where they capture and digest foreign agents. In the case of a large accumulation of pathogenic agents, white blood cells increase significantly in size and begin to break down. The process of destruction of leukocytes is accompanied by a local inflammatory reaction: swelling and hyperemia of the damaged area, an increase in local temperature.

Flora smear

A smear for flora, as already mentioned, is taken from a woman at every visit to the antenatal clinic, that is, every six months, if the patient has complaints, as well as after a long course of antibiotics, when planning a pregnancy, during gestation and after childbirth. During pregnancy, a smear for microflora (in the absence of complaints) is examined three times: during registration, before maternity leave(30 weeks) and at 36 weeks.

Preparing for the test

In order for the results of a smear on the flora to be reliable, it is necessary to prepare in advance for the test:

• exclude sexual intercourse for 1 – 2 days;
• Douching is not allowed 2 days before a visit to the doctor;
• the use of suppositories, tablets and creams is prohibited for at least 24 hours;
• a smear is not taken during menstruation, since menstruation changes the composition of the smear;
• 2 – 3 hours before visiting the gynecologist, refrain from urinating;
• You should wash yourself the day before your appointment with warm water without soap.

If a woman is preparing for a preventive examination, then it is advisable to schedule a visit to the gynecologist in the first days after her period or before it begins.

Procedure for collecting and examining material

IN gynecological smear determine the composition of the microflora of the contents of the urethra, vagina and cervix.

The material is collected using sterile disposable instruments. A smear is taken from the urethra with a bacteriological loop or a Volkmann spoon, from the vagina (posterior fornix) with a sterile gauze swab, and from the cervix with an Eyre spatula.

The following symbols are indicated on the slides:

• U – smear taken from the urethra;
• C – cervical smear;
• V – vaginal smear.

After the glasses are dry, they are sent to the laboratory for testing. Laboratory assistants stain smears with special dyes (Gram stains), then examine them under a microscope. During the analysis, leukocytes and various opportunistic and pathogenic bacteria are counted, which are painted in different colors.

Explanation of smear analysis

Data indicated in the smear analysis:

Leukocytes

The leukocyte rate depends on the location from which the smear was taken. Their content is normally small. In the urethra, the number of leukocytes is 0 – 5 – 10, in the vagina their concentration corresponds to 0 – 10 – 15, and in the cervical canal from 0 to 30.

During pregnancy, the content of leukocytes increases slightly and can range from 15 to 20 (in the vagina) in the field of view.

Flat epithelium

Flat epithelium lines the vagina, urethra and cervical canal. In normal smears, the number of epithelial cells ranges from 5 to 10. When the epithelium disappears (0 cells in the field of view), they speak of atrophy of the mucous membrane, and in the case of an increase in epithelial cells, inflammation.

Slime

Lactobacilli or Doderlein bacilli

Normal smears are characterized by a high content of them in the vagina, while they are absent in the cervix and urethra. When the number of lactic acid bacteria decreases, they speak of bacterial vaginosis.

Yeast

Fungi of the genus Candida are normally absent at all three points of smear collection, but their occasional presence in the vagina is allowed. An increase in yeast-like fungi indicates thrush.

"Key" cells

They are conglomerates of squamous epithelial cells and bacteria - gardnerella. Normally absent, the presence of such cells is a sign of gardnerellosis or bacterial vaginosis.

Leptothrix

Refers to anaerobic (living without air) gram-negative bacteria, often found in mixed infections, for example, thrush and bacterial vaginosis or trichomoniasis and chlamydia. If these bacteria are detected in a smear, an advanced analysis for sexually transmitted infections is indicated.

Others

• Mobiluncus - also refers to anaerobic microorganisms and is present in candidiasis or bacterial vaginosis.
• Trichomonas is a protozoan; normally they are absent from the smear.
• Gonococci - cause a sexually transmitted disease - gonorrhea, and are therefore normally absent.
• Escherichia coli - normally observed in single numbers in a vaginal smear. As the concentration of bacteria increases, bacterial vaginosis and neglect of personal hygiene are possible.
• Cocci - in gynecological smears are divided into gram-positive - colored blue and gram-negative - do not stain and remain pink. Gram-positive cocci include opportunistic bacteria: streptococci, staphylococci and enterococci, which are normally found in smears in single quantities. When their concentration increases, they speak of nonspecific vaginitis (colpitis).

Degrees of vaginal smear purity

When we talk about gynecological smears, we mean not only smears taken from the cervical canal, urethra and vagina, but also separate species a smear that determines the degree of cleanliness of the vagina. The material is collected from the walls of the vagina and dried on a separate glass. There are 4 degrees of purity, but only degrees 1 and 2 are considered normal:

• 1st degree - leukocytes 0 - 5

It is considered an ideal option. The number of leukocytes is small, the microflora is mainly (up to 95%) represented by lactic acid bacteria, and there are only a few epithelial cells.

• 2nd degree - leukocytes 5 - 10

It is also normal, but opportunistic microorganisms (cocci or single yeast fungi) are detected in small quantities in the smear. Lactobacilli predominate, leukocytes and mucus are moderate, epithelial cells are normal.

• 3rd degree - more than 10 (up to 50)

The content of leukocytes increases, a lot of mucus and epithelium are detected. The concentration of Doderlein bacilli decreases due to an increase in opportunistic flora.

• 4th degree - leukocytes completely (cannot be counted)

Against the background of a huge number of leukocytes (the term “entirely” is indicated in the description of the smear), pathogenic microorganisms (gonococci, trichomonas) are determined. Doderlein's rods are not detectable, there is a lot of mucus and epithelial cells (a consequence of the inflammatory process).

If grade 3 and 4 purity of the vaginal smear is detected, it is necessary to establish the cause of inflammation and carry out treatment.

Reasons for an increase in the content of leukocytes in a smear

If leukocytes in a smear in women are elevated, then the causes may be either diseases of the reproductive sphere or malfunctions of other internal organs and systems. Inflammation comes first among the causes of an increase in leukocytes in urogenital smears:

• inflammatory process in the cervical canal or cervicitis;
• development of inflammation in the appendages (tubes and ovaries) or salpingoophoritis;
• inflammation of the uterine mucosa – endometritis;
• inflammatory process in the vagina - colpitis or vaginitis;
• development of inflammation in the urethra – urethritis;
• malignant tumors of the genital organs (destruction of healthy tissue is accompanied by inflammation);
• intestinal and/or vaginal dysbiosis;
• infections that are sexually transmitted (both sexually transmitted diseases and hidden sexually transmitted infections).

Pathogenic microorganisms are the culprits of inflammation

Why do leukocytes increase in a smear? The development of the inflammatory process involves pathogenic microorganisms that are difficult to detect in the usual way - by examining a urogenital smear, or activated representatives of opportunistic flora. To detect pathogens of latent sexually transmitted infections, they resort to a more complex examination - the PCR method (examination of blood, urine, discharge from the genital organs).

A detailed study may reveal the following in smears or blood:

• chlamydia;
• mycoplasma and ureaplasma;
• gonococci (see symptoms of gonorrhea);
• Koch's bacillus (the causative agent of tuberculosis);
• Treponema pallidum (the causative agent of syphilis);
• Donovan bodies (causative agents of granuloma inguinale);
• trichomonas (see symptoms of trichomoniasis);
• amoeba;
• cytomegalovirus;
• human papillomavirus (cause of cervical cancer);
• immunodeficiency virus;
• genital herpes viruses;
• mushrooms of the genus Candida (thrush);
• actinomycetes fungi.

Other causes of increased white blood cell counts

Bacterial vaginosis or vaginal dysbiosis

Under certain conditions, opportunistic flora is activated and the growth of lactic acid bacteria is suppressed:

• disruptions in hormonal status (puberty or decline of reproductive function - pre- and menopause, pregnancy and spontaneous abortion, endocrine diseases);
• weakening of local and general immunity (hypothermia, antibiotic therapy);
• severe stress and overwork;
• microtrauma of the vagina due to intense sex;
• radiation treatment, chemotherapy;
• use of spermicides in the form of ointments and suppositories;
• oral sex;
• a large number of sexual partners;
• excessive adherence to the rules of intimate hygiene, passion for douching;
• entrance to the vagina deformed by scars ( anatomical features, pathological birth, surgical interventions);
• imbalance of intestinal microflora (dysbacteriosis);
• foreign bodies in the vagina (tampons).

Allergy

• allergies to medications and herbs;
• intolerance to lubricants (gels, ointments);
• intolerance to partner's sperm.

Irritation of the vulva and vagina

• neglect intimate hygiene;
• temperature changes (hypothermia and overheating);
• mechanical injury (tight, synthetic underwear, thongs, rough sex, etc.);
• chemical burns (douching with acids and other drugs);
• general diseases (diabetes mellitus, pathology urinary system and others).

In addition, elevated white blood cells in urogenital smears can be observed within 24 hours after coitus or for 7 to 10 days after installation intrauterine device. If the reason for the increase in the content of leukocytes in smears cannot be established, a more thorough and detailed examination should be carried out, including to identify malignant tumors of the reproductive system.

Causes of increased leukocytes in pregnant women

A slight increase in the level of leukocytes in a smear during pregnancy is considered normal. The normal content of white blood cells in vaginal smears corresponds to 15 - 20 per field of view.

Elevated leukocytes in pregnant women in a smear are explained by physiological factors:

• Firstly, during the period of gestation, a restructuring of the hormonal balance occurs, progesterone and estrogens are produced in large quantities. Under the influence of estrogens, Doderlein bacilli begin to actively multiply, which create an acidic environment in the vagina and prevent the proliferation of opportunistic and pathogenic flora, but contribute to the accumulation of leukocytes.
• Secondly, expectant mothers have a decreased immune system, which prevents the embryo from being rejected as a foreign body. Due to weakened immunity, pathogenic bacteria easily penetrate into the vagina or become activated hidden infection, which explains the increase in leukocytes in gynecological smears (a protective reaction during inflammation).

Often a very high concentration of white blood cells is detected in smears (50 - 100 or leukocytes completely in the field of view), which is usually noted with thrush (urogenital candidiasis). In such cases, in a smear, except large number leukocytes, fungi of the genus Candida and mycelium in the form of white threads are detected.

An excess of leukocytes in expectant mothers requires careful examination and appropriate treatment. The infectious process from the vagina can spread to the cervix and cervical canal, penetrate the uterine cavity, which will lead to infection of the amniotic fluid and fetus and result in miscarriage or premature birth.

Clinical manifestations

An increased level of leukocytes in secretions from the cervical and urethral canal and vagina often accompanies diseases of the female urinary and reproductive system:

• frequent and painful urination is a sign of cystitis or urethritis;
• false urge to defecate indicates intestinal dysbiosis;
• discharge from unpleasant smell accompanied by itching and burning may indicate vaginitis, cervicitis or inflammation of the uterus and inflammation of the appendages;
• purulent, foamy discharge or curdled discharge observed with vaginitis of a specific etiology (thrush, gonorrhea, trichomoniasis);
• pain during coitus is possible due to pathology of the cervix, uterus or appendages;
• menstrual irregularities combined with an increase in leukocytes makes one think about inflammation of the appendages.

Diagnostics that determine the direction of treatment

Before you start fighting increased level white blood cells in smears, it is necessary to establish the cause of this phenomenon. It often happens that the content of leukocytes in a gynecological smear is high, although there is no activation and growth of opportunistic flora and, especially, specific pathogens. What to do in such a case?

The gynecologist will recommend taking smears again, selecting the most successful day of the menstrual cycle and recommending that you properly prepare for the tests (exclude sexual intercourse, taking medications, douching). If, when taking smears again, the leukocytes again have a high level, an extended examination is carried out:

A smear from the cervical canal and vagina onto the tank. sowing

When vaginal and cervical secretions are sown on nutrient media, colonies of pathogenic and opportunistic microorganisms often grow. The pathogen is identified and its sensitivity to certain antibiotics is determined, which is necessary for further treatment.

PCR for latent sexually transmitted infections

The method is highly accurate and almost 100% detects hidden sexually transmitted infections, which may not manifest themselves clinically, but lead to irreversible consequences (infertility).

Ultrasound of the pelvic organs

In this case, preference is given to ultrasound performed with a transvaginal sensor. Possible reason elevated white blood cells In the tests, in addition to inflammation of the uterus and appendages, there may be various tumor-like formations (ovarian cysts, uterine fibroids or sarcoma, uterine polyps, etc.).

Colposcopy

Examination of the cervix under multiple magnification helps to diagnose diseases that are not visible to the naked eye, but are the cause of elevated white blood cells in tests (leukoplakia, cervical dysplasia or early stage cancer).

Consultations of related specialists

Appointed after the above examination. For example, consulting an endocrinologist and prescribing appropriate therapy will help normalize the level of leukocytes when diabetes mellitus, pathology thyroid gland or if you are overweight. A nephrologist will identify a disease of the urinary system (pyelonephritis, cystitis) and prescribe anti-inflammatory therapy (antibiotics, nitrofurans). The allergist will advise you to exclude irritating factors (synthetic underwear, the use of intimate sprays, deodorants and various lubricants). The neurologist will prescribe sedatives and medications to eliminate neurosis, which can also cause an increase in leukocytes.

Anti-inflammatory treatment

Anti-inflammatory treatment is prescribed only if an infection is detected. The doctor decides what to treat, depending on the test results. Anti-inflammatory therapy includes:

• local treatment;
• general treatment;
• restoration of normal vaginal microflora.

Local treatment consists of douching:

• the course is short and lasts no more than 4 – 5 days
• medications (solutions of potassium permanganate, chlorhexidine, miramistin)
• herbs (chamomile, sage, coltsfoot, calendula, St. John's wort). See how to do douching and whether it is necessary.

Candles:

• at the same time, suppositories with an anti-inflammatory effect are prescribed locally (hexicon, polygynax, betadine and others, see all anti-inflammatory suppositories in gynecology).
• if a diagnosis of urogenital candidiasis is made, it is recommended to use suppositories with an antifungal effect (clotrimazole, pimafucin, livarol, see all suppositories for thrush). Suppositories are administered once or twice a day for 10 to 14 days.
• when the inflammatory process is not started, treatment is limited to this.

Treatment of hidden sexually transmitted infections

If a viral infection is detected, venereal diseases or latent genital infections, systemic antibiotic therapy or antiviral drugs are prescribed. The choice of drug depends on the etiology of colpitis and/or cervicitis.

Restoration of the world flora

The final stage of therapy is the restoration of normal vaginal microflora (increasing the content of lactic acid bacteria). For this purpose the following are appointed:

• vaginal suppositories or tampons with probiotics (lactobacterin, bifidobacterin, acylact, colibacterin and others).
• The course of treatment with probiotics is long and lasts 2–4 weeks.

Question answer

Question:
What threatens high content leukocytes in tests?

If the high level of white blood cells in the tests is due to an inflammatory process, then refusal of treatment is fraught with infertility, ectopic pregnancy, the development of pelvic adhesions, uterine fibroids, endometriosis, menstrual irregularities and even the occurrence of malignant tumors of the genital organs.

Question:
I am pregnant and had a smear test, which revealed elevated white blood cells. Why is this dangerous?

A high content of white blood cells in smears during pregnancy is dangerous due to premature termination of pregnancy (miscarriage or premature birth), intrauterine infection of the fetus, the development of chorioamnionitis (inflammation of the waters and placenta), ruptures birth canal during childbirth and the development of purulent-septic diseases in postpartum period. Therefore, expectant mothers should follow the doctor’s recommendations with special care and carry out the prescribed or treatment if the leukocyte count in the tests increases.

Question:
Is it possible to have sexual activity with elevated leukocytes in smear tests?

If not identified specific infection(gonorrhea, chlamydia, genital herpes and other diseases), then having sex is not contraindicated.

Question:
Can I get pregnant if my smears show elevated white blood cells?

Yes, it is quite possible to become pregnant, but it is advisable to undergo preliminary treatment, since often a high level of leukocytes in tests indicates an inflammatory process in the genital organs.

Question:
Is it possible to reduce the content of leukocytes in tests using only traditional methods treatment?

You should not self-medicate, including treatment only with traditional medicine, if you have a “bad” smear test result. Only a doctor can identify the cause of “bad smears” and prescribe appropriate treatment. Reduce white blood cells in tests only with the help of traditional medicine is not possible, since treatment with antibiotics or antiviral drugs or therapy for concomitant diseases is often necessary.

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Interpretation of analyzes

A gynecological, or urogenital, smear helps diagnose many reproductive diseases. It determines the presence of pathogenic microbes, epithelial cells, shaped elements blood and other indicators.

Analysis of a smear for leukocytes is needed to identify not only infectious and inflammatory pathologies of the female genital organs, but also the severity of their course.

Indications for taking a smear

Leukocyte in a smear

A smear for microflora is taken when examining a woman for the prevention and diagnosis of gynecological diseases. Indications for delivery are:

• pathological vaginal discharge;
• disruptions in the menstrual cycle;
• pain in the lower abdomen;
• itching, soreness and burning in the vagina, urethra and during urination;
• discomfort during intimacy;
• long-term use of antibiotics, hormonal agents and other drugs;
• pregnancy, analysis is required in the first trimester

But even if there are no such symptoms, a smear should be taken every three months, since many pathologies are asymptomatic. Material for a smear in women is taken from the walls of the vagina, urethra and cervix with a disposable spatula.

This is a quick, simple and painless procedure, and it brings pain and discomfort only when the walls of the urethra are affected - when there is an infection or inflammatory process.

Preparing to take a smear

You should prepare for the procedure, since some factors lead to false test results - detection of leukocytes in the absence of diseases, or vice versa.

Preparation for taking a smear is as follows:

1. Refusal of sexual intercourse 3 days before visiting the doctor;
2. Stop taking medications of any form (tablets, suppositories, douching, injections, ointments) a week before the study;
3. For 2 days before the analysis, neither soap nor gel should be used for hygiene of the external genitalia - only warm water, and the last intimate toilet is carried out the night before;
4. 3 hours before the test you should not urinate.

A smear is not taken during menstruation, except for urgent diagnosis. Best time for analysis - the first days after menstruation or shortly before their onset.

What do you pay attention to when deciphering an analysis?

In interpreting the results of the analysis, the degree of increase in leukocytes is important. The more there are, the more acute the infectious or inflammatory process.

For example, very high rates are detected in cases of recent infection with a venereal disease, in the case of an acute form of inflammation of the appendages, or colpitis.

If leukocytes are elevated in the smear, then attention is paid to other values ​​of this bacteriostatic analysis, since leukocytosis accompanies a change in the number of other elements.

For example, with thrush there is the presence of fungal flora, with bacterial vaginosis and gonorrhea - coccal microorganisms, with inflammation of the vagina or endometritis the number of bacteria increases Staphylococcus aureus. But the population of lactobacilli, which are present normally, and the acidity of the environment can be reduced.

White blood cells in a smear are normal in women, table

In the laboratory, when studying a smear under a microscope, the number of leukocytes in the field of view is counted, the norm does not exceed 15. In a healthy girl or woman, a small number of white blood cells are always present in the vagina.

When an infection appears, they recognize foreign cells and begin an active fight - their number increases significantly.

This table shows the norm of leukocytes in a smear in women and other healthy indicators that are determined by the analysis.

Normally, gynecological smears also do not reveal gardnerella, gonococci, trichomonas, chlamydia, atypical cells and yeast-like fungi (candida).

Analysis results are usually ready within 2-3 days or on the same day.

If the study shows a high level of leukocytes, then the doctor’s next task is to identify the exact cause of their increase.

To do this, they use PCR analysis (DNA diagnostics of the pathogen), bacteriological culture, take smears for latent infections and cytology (Pap test), and, if necessary, prescribe other diagnostic methods.

The cause of elevated leukocytes in a smear in women

Infection or inflammatory process in genitourinary organs is always accompanied by an increase in leukocytes in a woman’s smear. The reason for the increase in their level may be hidden in various diseases:

• inflammation - appendages (adnexitis), uterine mucosa (endometritis), urethra (urethritis), cervical canal (cervicitis), vagina (colpitis);
• benign and malignant tumor formations genitourinary area;
• STDs – syphilis, trichomoniasis, gonorrhea, chlamydia or others;
• dysbacteriosis – vagina or intestines;
• systemic diseases;
• hormonal imbalance.

Deviations from the norm in the analysis of leukocytes can be associated with frequent stress, chronic fatigue, long-term use of antibiotics and other medications.

Sometimes active sexual life leads to a moderate increase in white blood cells in a smear - up to 25 cells.

Leukocytes during pregnancy

The norm of leukocytes in a smear in pregnant women is 15-20 cells per field of view. During pregnancy, the woman is tested several times - the first at the earliest stages during registration.

A high level of leukocytes in this case can indicate an acute pathological process, and about the presence of a latent infection, which worsened after pregnancy.

Most often this inflammatory diseases caused by STDs, or thrush (candidiasis). After an accurate diagnosis, local treatment is prescribed, and if it does not have an effect, then antibiotic therapy or other methods are selected, depending on the time period.

• Full decoding of the smear for flora, norms

Almost always, leukocytes in a smear in women (the norm of which is exceeded several times) indicate the development of serious inflammation in the body.

What kind of pathology this is and for what reason it arose, doctors can only establish based on the results of an additional examination.

Therefore, in no case should you self-medicate, which can cause negative consequences.

Causes of leukocyturia in a smear

If the norm of leukocytes in a smear in women is significantly increased, then the reasons for this behavior of the body may lie in pathological changes in the reproductive organs.

In addition, an increase in white cells in the smear and urine is possible due to disturbances that have occurred in the functioning of other vital systems of the body.

The list of main reasons for an increase in leukocytes in a general smear in women includes:

• pathology of the cervical canal;
• pathology of the uterine appendages;
• endometritis and colpitis;
• inflammation of the urinary tract;
• neoplasms in the internal genital organs;
• violation of the microflora of the vagina or intestines;
• venereal diseases;
• latent sexual infections.

The reasons why leukocytes in a smear in women may be elevated are associated with pathogenic bacteria, in most cases these are conditionally dangerous microorganisms.

It is difficult to detect microscopic pathogens using only a urogenital smear, so a comprehensive examination method, PCR, is used to identify them.

In this case, we are talking about studying blood tests, urine and vaginal discharge.

During such a study, chlamydia, gonococci, trichomonas, fungi of the genus Candida, a viral infection that develops against the background of suppressed immune antibodies of the body, and genital herpes can be detected in a smear.

Other common causes of leukocyturia in a smear in women are:

• bacterial vaginosis;
• allergies to medications;
• irritation of the external genitalia;
• installation of an intrauterine device;
• pregnancy period.

A condition such as bacterial vaginosis may be a consequence of puberty or be a sign of declining fertility.

The occurrence of vaginal dysbiosis is associated with a weakening of the body’s general immunity, microtraumas of the vaginal passage and an imbalance of microflora in the intestine.

If the reason for the increase in white cells in a woman’s smear comes down to an allergic reaction, then the body’s response may occur not only to medications pharmaceutical drugs, but also for herbal decoctions prepared according to folk recipes.

In addition to these factors, there may also be a reason such as intolerance to the sperm of the sexual partner.

Often, an increased level of leukocytes in a smear is a consequence of irritation of the vaginal passage, which can occur if a woman neglects intimate hygiene, with hypothermia or overheating, with a chemical burn - this means douching with pharmaceutical drugs.

If not one of the items indicated in the list is the cause of the increase in white cells in a woman’s general smear, then the patient is prescribed an additional examination of the body, including oncology of the reproductive organs.

White cell norm

A woman’s smear always has elevated leukocytes before menstruation, which is considered normal. The permissible deviation from the norm in the form of 15–20 cells in the field of view is associated with the period of pregnancy.

An analysis of a vaginal smear for microflora in a woman carrying a child is done in the first trimester of pregnancy, upon registration at the antenatal clinic, then at 30 and 36 weeks.

If the leukocyte count in the smear is too high, then the pregnant woman must be examined for the presence of a hidden infection or pathology that could have worsened due to hormonal changes.

An overly active sex life can lead to a moderate increase in white cells in the analysis.

Material for diagnosing the level of leukocytes is taken from the cervical canal, urethra and vaginal passage.

At the same time, there is a specific norm for smears made in different areas of the female genital organ.

There is no clear answer to the question of what is the ideal rate of leukocytes in a smear.

A completely normal smear is a rare occurrence, especially when it comes to vaginal test results.

And if in this case a small error is allowed, then it should be absent in smears taken from the urethra and cervix, which is possible only in the absence of pathologies.

The degree of sterility of the vaginal passage is determined using an additional smear. The biomaterial is collected from the mucous membrane of the walls of the vaginal passage, after which the fragment under study is dried on a special glass.

There are four degrees of sterility of the female internal genital organ, but only I-II are the norm:

• the first degree assumes the number of leukocytes from 0 to 5, approximately 95% of the microflora are lactic acid bacteria;
• at the second level of vaginal cleanliness, the smear contains from 5 to 10 units of white cells. In a woman’s general smear, yeast-like fungi and cocci, which belong to the opportunistic flora, may be occasionally present. Lactobacilli predominate, mucus and white cells are present in minimal quantities, the epithelium is normal;
• the third degree of vaginal sterility has from 10 to 50 units of leukocytes, characterized by the presence of a large amount of mucus and epithelium in the smear. Due to the increase in opportunistic microflora, there is a decrease in the level of Dederlein bacilli;
• in the description of a smear of the fourth degree of sterility of the vagina, there is no count of leukocytes; their number is marked with the term “entirely”, i.e. they cannot be counted. In addition to leukocytes, a woman’s smear contains pathogenic microflora, represented by Trichomonas and gonococci.

When diagnosing III and IV degrees of sterility of a vaginal smear, the cause of inflammation is established, after which the woman can be prescribed effective treatment.

Diagnosis of leukocyturia problems in women

Having discovered an excess of white cells in smears taken in different places of a woman’s internal genital organs, the attending physician first determines the cause of this condition, then chooses the direction of treatment.

In specific cases, the level of leukocytes in an analysis done for vaginal flora may be exceeded, but the activation and growth of potentially dangerous microflora is not observed, and most importantly, there are no pathogens in the analysis. In such a case, the woman is prescribed a repeat smear.

If it turns out that the level of leukocytes in a woman’s smear is indeed elevated, then to establish the causes of this condition there is a need for an extensive examination, which includes:

• taking smears for bacterial culture;
• PCR diagnostics of sexually transmitted infections;
• ultrasound examination of the internal organs of the pelvis;
• examination of the cervix by colposcopy;
• visiting related specialists.

When bacteriologically inoculating secretions from the female genital organs on wide range Colonies of bacteria of conditionally dangerous and dangerous types are detected in nutrient media.

The type of pathogen is identified and its sensitivity to different types antibiotics to improve the effectiveness of treatment.

PCR or polymerase chain reaction is a highly accurate method for detecting latent sexually transmitted infections that cannot be detected by external symptoms.

If hidden infections are not diagnosed and treated in time, they can cause infertility.

Ultrasound examination of the internal organs of the pelvis using a transvaginal sensor allows you to obtain information about the condition of the walls of the uterus and its appendages (inflammation, neoplasms, compaction).

Colposcopy allows you to accurately diagnose diseases of the internal genital organs.

This method makes it possible to examine the cervix using multiple magnification its walls and identify at an early stage oncology, leukoplakia and dysplasia, which provoke an increase in the level of leukocytes in smears.

The attending physician prescribes a visit to related specialists upon completion of the above examination methods.

The list of specialists from whom patients are recommended to consult includes an endocrinologist.

If an increase in leukocytes in smears occurs due to diabetes, excess weight or thyroid disease, then the endocrinologist will help normalize the abnormal indicator by prescribing the necessary therapeutic treatment.

A consultation with a nephrologist will come in handy if pathology develops in the urinary system.

Patients whose increase in leukocytes in smears is affected by irritating factors are referred to an allergist.

A neurologist will help you cope with a neurotic disorder, which may cause an increase in the level of white cells in the microflora of the genital organs.

How to cure leukocyturia?

Once the cause of the increase in leukocytes in smears has been established, the doctor chooses treatment: the direction depends on the type of pathology, which can be inflammation, a hidden sexually transmitted infection, or a microflora disorder.

The doctor decides what medications to treat the inflammatory process after studying the test results.

As a rule, anti-inflammatory treatment consists of local and general therapy and ends with the normalization of microflora in the vaginal passage.

Local treatment involves douching for 4-5 days using herbal decoctions, chlorhexidine or potassium permanganate solution, after which anti-inflammatory suppositories are used.

If the inflammation is provoked by a microorganism of the genus Candida, then suppositories with an antifungal effect are prescribed.

Suppositories are administered daily for two weeks. Local treatment gives a quick result, provided that the inflammation is not advanced.

If female body attacked by a latent infection, venous disease or virus, then the patient with a similar diagnosis is attributed antibacterial drugs or taking antiviral drugs medicines. The choice of drugs takes into account the etiology of the disease.

Upon completion of local and general therapy, agents are prescribed to normalize the vaginal flora. In order to increase the level of lactic acid bacteria, patients are prescribed vaginal suppositories with probiotics - due to them, the course of treatment is extended for another three to four weeks.

Some women do not consider it dangerous to increase the level of leukocytes in gynecological tests and refuse treatment altogether or try to remove the inflammatory process folk remedies, take various vitamin complexes (B vitamins, vitamins A, C, D, E).

Neglect of their health threatens such women with infertility or ectopic pregnancy, pathological changes in the walls of the uterus, disruption of the menstrual cycle and the formation of malignant lumps.

If the level of leukocytes has exceeded the permissible level in a smear in a woman carrying a child, then she should take the treatment prescribed by the gynecologist as responsibly as possible.

Otherwise the risk increases premature birth In addition, there is a possibility of intrauterine infection of the fetus and the appearance of purulent formations.

Considering these factors, you should not plan a pregnancy with elevated white cells in the tests until you have completed the course of treatment prescribed by your doctor.

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 diagnostic 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 antibacterial 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.

WITH 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, and abbreviations are the first letters of each analysis parameter. To understand the normal microflora of the vagina, knowledge of the letter designations will be very helpful.

So, what are these letters:

1. abbreviations of the 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);
2. L - leukocytes, the value of which may not be the same in normal conditions and in pathology;
3. Ep - epithelium or Pl.Ep - squamous epithelium;
4. GN - gonococcus (the “culprit” of gonorrhea);
5. Trich - Trichomonas (causative agents of trichomoniasis).

In the smear, mucus may be detected, indicating a normal internal environment (PH), beneficial Doderlein bacilli (or lactobacilli), the value of which is equal to 95% of all beneficial bacteria.

Some laboratories make it a rule to mark the content of a specific type of bacteria. For example, somewhere they use the “+” sign for this. It is put into 4 categories, where one plus is an insignificant content, and the maximum value (4 pluses) corresponds to their abundance.

If there is no flora in the smear, the abbreviation “abs” is indicated (Latin, this type of flora does not exist).

What doctors don't see with microscopy?

Using this analysis, the following conditions or diseases of the body cannot be determined:

1) Cancer of the uterus and cervix. To diagnose malignant degeneration of the endometrium, histological material is needed, and in large quantities. And they take it directly from the uterus during separate diagnostic curettage.

2) . To determine it, a smear is not needed and it does not matter what result it shows. It is necessary to take a blood test for hCG, undergo a gynecological examination by a doctor, or do an ultrasound of the uterus. It is possible to detect human chorionic gonadotropin in urine, but not in genital discharge!

3) CC and other pathologies (leukoplakia, koilocytosis, HPV lesions, atypical cells, etc.) are diagnosed based on the results of a cytological examination. This analysis is taken directly from the cervix, from the transformation zone, using a certain method with Papanicolaou staining (hence the name of the analysis - PAP test). It is also called oncocytology.

4) Does not show infections (STDs) such as:

• (chlamydia);
• (mycoplasmosis);
• (ureaplasmosis);

The first four infections are diagnosed using the PCR method. And to determine the presence of the immunodeficiency virus by a smear with high accuracy impossible. You need to take a blood test.

Smear standards for flora

After receiving test results, it can sometimes be very difficult to understand the numbers and letters written by the doctor. It's actually not that complicated. In order to understand whether you have gynecological diseases, you need to know the normal indicators when deciphering the smear analysis for flora. There are not many of them.

In smear tests in an adult woman, the normal indicators are as follows:

1. – must be present, but only in small quantities.
2. (L) – The presence of these cells is allowed because they help fight infection. The normal number of leukocytes in the vagina and urethra is no more than ten, and in the cervical area - up to thirty.
3. (pl.ep.) – normally its quantity should be within fifteen cells in the field of view. If the number is higher, then this is evidence of inflammatory diseases. If less is a sign of hormonal disorders.
4. Dederlein sticks - a healthy woman should have a lot of them. A small number of lactobacilli indicates a disturbed vaginal microflora.

The presence of Candida fungi, small rods, gram(-) cocci, Trichomonas, gonococci and other microorganisms in the analysis results indicates the presence of a disease and requires a more in-depth study and treatment.

Table for deciphering the normal smear in women (flora)

A breakdown of the results of a smear analysis for flora in women is presented in the table below:

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.

1. First degree of purity: The number of leukocytes is normal. Most of the vaginal microflora is represented by lactobacilli (Doderlein bacilli, lactomorphotypes). The amount of epithelium is moderate. Mucus - moderate. The first degree of purity means that everything is normal for you: the microflora is fine, your immunity is good and you are not in danger of inflammation.
2. Second degree of purity: The number of leukocytes is normal. The vaginal microflora is represented by beneficial lactobacilli along with coccal flora or yeast fungi. The amount of epithelium is moderate. The amount of mucus is moderate. The second degree of vaginal cleanliness is also normal. However, the composition of the microflora is no longer ideal, which means that local immunity is reduced and there is a higher risk of inflammation in the future.
3. Third degree of purity: The number of leukocytes is higher than normal. The main part of the microflora is represented by pathogenic bacteria (cocci, yeast fungi), the number of lactobacilli is minimal. There is a lot of epithelium and mucus. The third degree of purity is already inflammation that needs to be treated.
4. Fourth degree of purity: The number of leukocytes is very large (the entire field of view, completely). A large number of pathogenic bacteria, the absence of lactobacilli. There is a lot of epithelium and mucus. The fourth degree of purity indicates severe inflammation that requires immediate treatment.

The first and second degrees of purity are normal and do not require treatment. At these degrees, gynecological manipulations are allowed (cervical biopsy, uterine curettage, hymen restoration, hysterosalpingography, various operations, etc.)

The third and fourth degrees of purity are inflammation. At these degrees, any gynecological manipulations are contraindicated. You need to first treat the inflammation and then take the smear test again.

What is coccal flora in a smear?

Cocci are bacteria that have a spherical shape. They can occur both normally and in various inflammatory diseases. Normally, single cocci are detected in the smear. If immune defense decreases, the amount of coccobacillary flora in the smear increases. Cocci can be positive (gr+) or negative (gr-). What is the difference between gr+ and gr- cocci?

To describe bacteria in detail, microbiologists, in addition to indicating their shape, size and other characteristics, stain the preparation using a special method called “Gram staining”. Microorganisms that remain colored after washing the smear are considered “gram-positive” or gr+, and those that become discolored when washed are “gram-negative” or gr-. Gram-positive bacteria include, for example, streptococci, staphylococci, enterococci, and lactobacilli. Gram-negative cocci include gonococci, Escherichia coli, and Proteus.

What are Doderlein sticks?

Doderlein bacilli, or, as they are also called, lactobacilli and lactobacilli, are microorganisms that protect the vagina from pathogenic infections by producing lactic acid, which helps maintain an acidic environment and destroy pathogenic flora.

A decrease in the number of lactobacilli indicates a disturbed acid-base balance of microflora in the vagina and a shift towards the alkaline side, which often occurs in women who are sexually active. The pH of the vagina is significantly influenced by both pathogenic microorganisms and opportunistic microorganisms (which are sometimes found in the vagina normally).

Flora smear during pregnancy

The microflora of each woman is strictly individual, and normally consists of 95% lactobacilli, which produce lactic acid and maintain a constant pH of the internal environment. But opportunistic flora is also normally present in the vagina. It got its name because it becomes pathogenic only under certain conditions.

This means that as long as there is an acidic environment in the vagina, opportunistic flora does not cause any inconvenience and does not actively multiply. These include yeast-like fungi, which under certain conditions can cause vaginal candidiasis, as well as gardnerella, staphylococci, streptococci, which under other conditions can cause bacterial vaginosis (inflammatory process) in a woman.

A woman’s flora can change due to the most various reasons– with decreased immunity, taking antibiotics, with general infectious diseases and diabetes mellitus. 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 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 testing using the PCR method ( polymerase chain reaction), 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.