What does that mean? There are single leukocytes in the smear. Smear as a diagnostic method: norms for women and men, preparation for analysis, results

Laboratory methods diagnostics in obstetrics and gynecology – important component assessment of the health status of the female body.

Among their diversity, a simple smear on the flora has stood apart for many decades.

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

This study allows you to assess the composition of the microflora, count the number of leukocytes and epithelial cells, and also diagnose some STDs (gonorrhea, trichomoniasis).

This is a routine, non-invasive, economical and quite informative method, widely used in the work of a gynecologist.

Based on its results, the doctor has the opportunity to determine further tactics for managing the patient and prescribe appropriate treatment.

When is the analysis performed?

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

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

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

2. Collection of material for research

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

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

Vaginal discharge is multicomponent, it includes:

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

2.1. Preparing for a smear collection

Before collecting material, a woman must meet certain conditions:

1 It is better to take the analysis on days 5-7. The collection of discharge is not carried out.
2 Avoid the use of vaginal suppositories, lubricants, douching and sexual intercourse 24 hours before the test.
3 There is no need to use scented products before taking a smear. intimate hygiene, it is better to toilet the external genitalia with running water.
4 It is not advisable to take hot bath on the day of the analysis.

2.2. Technique for obtaining material

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

3. How to decipher the results?

3.1. Normal flora

IN lately normal composition vaginal microflora began to be paid special attention, since it has been proven that it is this factor that determines reproductive health women, provides local immunity, protection against pathogenic bacteria, normal onset and course of pregnancy.

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

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

Each woman has 1-4 types of lactobacilli in her vagina, and their combination is purely individual.

When deciphering the results of the analysis, it is impossible to conduct a detailed analysis of the vaginal microflora; the laboratory assistant evaluates only the ratio of rods and cocci.

The absence of cocci and a large amount of gram-positive rod flora (++++) is equated to grade 1 vaginal cleanliness. This is observed quite rarely; this situation is more typical for control smears after vaginal sanitation or taking antibiotics.
A small number of cocci (+, ++) is considered normal and indicates 2 degrees of purity, but only if rod flora (++, +++) is also detected. This is a good stroke.
Pathological is considered (+++, ++++) against the background of a decrease in the number of rods (+, ++). This result is called grade 3 vaginal cleanliness. This situation requires a detailed examination.
A large number of cocci (++++) and complete absence gram-positive rods (Gram + rods) in the smear indicate 4 degrees of purity. In this case, the woman requires mandatory treatment.

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

3.2. Gonococci and Trichomonas (Gn, Tr)

3.7. Yeast-like fungi

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

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

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

Should not be detected. In exceptional cases, their single detection is allowed in material taken from the posterolateral vaginal vault, as a component of the facultative flora. It is important to take into account the presence/absence of complaints and clinical manifestations.

The detection of spores and mycelium of the fungus in a smear indicates vaginal candidiasis and requires appropriate specific treatment.

Although it is a fairly informative diagnostic method, it is relevant only when comparing the microscopy result with complaints and clinical manifestations.

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

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

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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 further diagnostics, pick up deeper and informative methods research.

What do you pay attention to when deciphering an analysis?

Smear analysis allows you to evaluate indicators: leukocytes, cells squamous epithelium, 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 immune system protect the body from foreign agents, be it 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 fact 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, but 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
Diagnostic criterion	Vagina (V)	Cervix (C)	Urethra (U)
Leukocytes (Le)	0-10	0-30	0-5
Mucus	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 we're talking about about 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 (normoflora), leukocytes cover the entire field of view, the content of mucus and epithelial cells is increased. In addition, they are found in large quantities pathogenic microorganisms. 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 interpret its meanings without regard to others diagnostic signs shouldn't.

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 for them all to proceed smoothly, balanced work is important endocrine organs producing hormones. 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, the smear marks increased content leukocytes. 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 on real state 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.

This diagnostic procedure After the start of sexual activity, every woman should undergo regular testing: at least once a year. In addition to preventive examinations, a smear should also be taken during pregnancy. If there are no alarming symptoms, the expectant mother will have to undergo 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 affect the vaginal microflora in a negative way: cause death 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.

Objects to take biopsy material The pelvic organs serve:

vagina;
urethra;
urinary channel;
lower segment of the uterus (cervix);
cervical canal.

If there is a suspicion of problems with the reproductive organ or there is not enough information for an accurate diagnosis, then the research is carried out more deeply: taking aspirates from the uterine cavity is prescribed. Under certain conditions, smears are applied to glass and stained with formaldehyde. This makes it possible to identify serious, malignant problems in the reproductive organ.

During the process the following may be discovered:

yeast/fungi of a unicellular structure;
diplococci/round bacteria;
Trichomonas/Trichomonas vaginalis.

This diagnostic method allows you to find out different representatives biocenosis of the genital area in women. It will not allow you to detect more serious pathologies. An extensive search will yield only a cytological examination.

In the margins of the laboratory system, cytology is a special space. Taking smears for flora and cytology are different areas and specialists who prove various pathologies. The science of cytology is a branch of biology that studies cells and their structure. Widely used in medicine.

Through the science of cytology, reactions to external stimuli are also studied. Thanks to this in modern world It became possible to find not only the disease itself, but also ways to reduce inflammatory attacks, as well as treatment options.

The study of flora occurs in an accessible microscopic way. Typically, such a study is prescribed when scheduled inspection. Cytology is not included in the general examination. When studying the proposed material, the main attention is paid to the structure/structure of the cell. Pathology in the uterus is detected by studying the inner layer of this organ and the cervical canal. Various diseases the genitourinary system is studied by taking an analysis from the urinary canal, as well as the bladder. The norm is when the cylindrical epithelium, leukocytes and microorganisms that came from the vagina are clearly visible (in small quantities). The results are informative thanks to the staining of the cytological specimen, but the specialist’s perspective and knowledge also play an important role.

Attention! Every woman, at least once a year, is simply obliged to regularly undergo a cytology test. Only this method will allow us to identify cancer diseases.

Indications for testing

Tests for microflora from the tissue of the genitourinary system are very important for every woman. They allow you to diagnose the epithelial layer of the entire system and promptly identify the disease.

To determine diseases, the nature of which we will call sexually transmitted, the indications for concern are primarily vaginal discharge/burning/itching. Discharge (foamy/purulent/curdled) is already a reason to suspect thrush, gonorrhea, or trichomoniasis.

To determine a more serious pathology of the genitourinary system, telling us about elevated level leukocytes, the following symptoms should be present:

acute pain in the pelvic area;
frequent, painful urination;
itching/burning sensation;
foul odor/purulent discharge;
failure of the menstrual cycle;
infertility;
discomfort when walking/sexual intercourse;

All of the above are signs of such serious illnesses such as: cystitis/urethritis, adnexitis, various pathologies cervix and appendages, endometritis, cancer.

Attention! Timely, or better yet systematic, appeal to medical institution will help you maintain not only your health, but also your life. Many diseases lead to infertility. Constant monitoring and testing will ensure your normal sex life, childbearing and will help prevent a serious diagnosis.

Preparing for the test

To ensure the reliability of the information, preparation is required, which will take three days. Three days before the test you should refrain from:

from intimacy of a sexual nature;
immersion in a bath, pool/any douching;
use of medicinal suppositories.

Also preferred small diet, including fiber and excluding harmful products, alcohol.

The delivery procedure is virtually painless, but very important. That is why you need to take seriously both the preparation and the test itself.

Analysis transcript

At healthy condition in the fairer sex, the number of lactobacilli is 90-95%. These microorganisms work for a process that protects the genitals from external attacks by maintaining the required acidity in the microflora. Any violations lead to the opposite result.

To record tests in medicine, the initial letters of the Latin alphabet are used.

Letters to indicate the place where tests are taken

Others medical terms, used for analyses:

Also in laboratories I use the “+” sign, which is divided into four categories, calculated by increasing number.

«+» / small quantity;
«++» / average number;
«+++» / increased quantity;
«++++» / plentiful quantity.

Abs – indicates the absence of microorganisms.

Treatment is prescribed after a thorough examination.

Availability mucus product is present in every woman, but mucus should not get inside the urethra or urinary canal, otherwise it will cause inflammation.
The number of epithelium and leukocytes that exceeds the norm will also indicate inflammation.
The presence of an organism such as candida is acceptable, but in very small numbers. Their reproduction is facilitated not only by uncontrolled sexual intercourse, but also by simpler things: decreased immunity, fatigue.
Microorganisms such as Trichomonas indicate the presence of a corresponding disease;
Gardnerella for the presence of gardnerellosis.
Gonococci will show gonorrhea in the results.
Fungi of the genus Candida are an indicator of dysbiosis (reduction of Doderlein bacilli).

Degrees of vaginal smear purity

Taking a smear is not only to identify microorganisms, but also to determine the degree of cleanliness of the vagina. This is a separate collection of material, which is carried out by taking material from the walls of the vagina. Then, the material is dried on individual glass.

For indications of purity, 4 degrees were determined. Of these, the first two are accepted as the norm, degrees 3 and 4 determine the presence of pathology.

The number of white blood cells/leukocytes is approximately 0 - 5, a small number of bacteria are observed in the microflora, and the maximum number of Doderlein bacilli is recorded. The indicators are considered ideally pure and are given the first degree.

The amount is from 5 to 10, in a smear, microorganisms such as yeast fungi or cocci are present to a minimum. The number of rods is considered sufficient, mucus and the presence of white bodies are found in a moderate order. The second degree is diagnosed.

An increase in the number of corpuscles to 50 also reveals an increase in mucus, the level of Doderlein rods decreases significantly. The third degree is diagnosed.

If the quantity is no longer countable, then you can see such a term when describing the analysis as “completely”. Various venereal microorganisms are also found. There are no rods that can protect the body, the level of mucus and epithelial cells increases (a kind of buildup). The last degree is diagnosed.

Attention! The fourth/last degree is a clear sign serious inflammatory process. If you already have the third, and even more so the fourth degree, you should first go to a medical institution, retake tests, establish the cause, and then receive treatment.

Leukocytes in a smear are normal in women

Every woman has a minimum number of white blood cells in her blood. Therefore, the count from 0 to 30 is taken as the norm.

An increase in white blood cells will be a clear sign of the disease inflammatory in nature. If the white blood cell count exceeds all acceptable standards, then this will be a clear sign of cancer.

Norm of leukocytes during pregnancy

Pregnancy causes an increase in white blood cells

The increase occurs for several reasons:

adjustment of hormonal levels;
decreased immunity;
concentration/accumulation of white bodies.

Against the background of an increase in the production of the hormone estrogen, the amount of acidic environment, Doderlein sticks. This contributes to the concentration of leukocytes, a kind of their defensive reaction.

Indicators with high concentrations (from 50 to 100) in pregnant women do not yet indicate oncological problems. Such numbers are observed in the process of thrush/urogenital candidiasis.

Attention! Thrush is not a protective reaction of the body, but an infection that negatively affects the fetus and requires particularly careful treatment before birth. It can cause miscarriage and also “poison” birth canal for the baby.

The norm of leukocytes in a smear before menstruation

Tests before menstruation are considered “dirty”. In terms of the number of cells in a smear, the norm corresponds to the standard test results that pregnancy will show (see table for pregnant women). This is due to a glitch in hormonal background. In cases of increased indicators, it is recommended to retake the tests a week after the menstrual cycle, and then draw conclusions.

The norm of leukocytes in a smear after menstruation

After menstruation, the deviation is observed to a minor extent, since the body has not yet been completely cleansed.

Inconsistency with standard data is not a reason to panic; repeated tests are recommended a week after menstruation.

The norm of leukocytes in a smear in virgins

The number of leukocytes in virgins corresponds to the purity of the smear in adult, healthy women; this table indicated above should be a guideline.

The reasons for the increase in white blood cells may be the following factors:

failure to comply with hygiene standards;
use of dirty/other people's linen, including new underwear and bed linen;
hypothermia;
visiting public swimming pools, baths;
masturbation.

Starting from the age of 10-11, it is already possible to take the girl to a gynecologist for tests.

Reasons for the growth of leukocytes in a gynecological smear

A slight increase in the number of leukocytes may indicate an inflammatory type pathology, but is not yet a negative result. First, laboratory technicians look at the presence of these cells, and then at their condition. If the cells are destroyed, pathology is confirmed. Calm, undestroyed bodies, even slightly exceeding the above amount, are not a sign of any acute diseases.

A smear with a thick consistency is often misleading. It is difficult to see, since the cells seem to be superimposed on one another, mixed with leukocytes. In this case, it is recommended to take tests twice.

Attention! Repeating tests is, in principle, useful, because laboratory errors are not uncommon even in the modern world. Incorrect preparation for the test can also be a bad result.

Reasons for the decrease in the number of leukocytes

Everything in the body is interconnected. A decrease in white cells is not always an indication of health. In such cases, it is recommended to take another blood test. If leukocytes have decreased there too, this may also indicate a process of serious inflammation. Most often, low numbers indicate problems in endocrine system, gastrointestinal disorders, various viruses.

Monitoring the level of leukocytes is important at any age, since for young women this is fraught with infertility, and for mature women with serious illnesses. Also low level will be an indicator of decreased immunity.

Conclusion

You need to watch your body early age. A woman is a continuation of humanity, her reproductive organ must always be healthy, otherwise it will have a detrimental effect on both her and the unborn baby. Visit a gynecologist at least once a year, get tested and get timely treatment- the key to a healthy generation.

Flora smear in women - laboratory test, which identifies the types of bacteria that are present in the vagina. This is the most common and simplest method for detecting inflammation and STDs (sexually transmitted diseases).

The examination is absolutely painless. It is produced during normal gynecological examination. The doctor takes the material with a disposable spatula from the walls of the vagina and cervix. The contents of the vagina (vaginal secretions) are applied to the glass. In the laboratory, the material is stained so that the bacteria become clearly visible.

Purpose of the study

determine the state of the vaginal microflora;
identify sexually transmitted infections and their causative agent;
determine the degree of the inflammatory process;
assess the degree of vaginal cleanliness, which is mandatory before further diagnostic studies And gynecological operations- cauterization of erosions, removal of polyps, curettage;
assess the health status of pregnant women.

When does a gynecologist take a smear for flora?

complaints of itching or vaginal discharge, other symptoms of inflammation;
preventive examinations;
control of the treatment;
reception hormonal drugs and immunosuppressants;
control of microflora in the background long-term use antibiotics;
pregnancy. It is carried out 3 times during pregnancy (at registration, at the 30th and 36th week).

This study has many names: smear for flora, general smear, bacterioscopy, smear for cleanliness. There are also smears for flora from the urethra and cervical canal. Usually these three types of smears are performed together.

Normal vaginal microflora

A healthy woman's vagina is not sterile. It contains many types of microorganisms, their totality is called microflora. Bacteria constantly compete with each other for habitat on the walls of the vagina and for food.

The most numerous are lactobacilli and bifidobacteria, which attach to the vaginal epithelium. They produce alcohols, peroxide, lactic and other acids, which provide an acidic reaction in the vaginal secretion. As well as lysozyme and other enzymes that inhibit the proliferation of other types of bacteria.

Microorganisms that make up the microflora of a healthy woman

Microorganisms	Number of CFU/ml
Lactobacilli or Doderlein sticks Lactobacillus spp.	10 7 -10 9
Bifidobacterium Bifidobacterium spp.	10 3 -10 7
Clostridia Clostridium spp.	Up to 10 4
Propionibacterium spp.	Up to 10 4
Mobiluncus Mobiluncus spp.	Up to 10 4
Peptostreptococcus Peptostreptococcus spp	10 3 -10 4
Corynebacterium spp.	10 4 -10 5
Staphylococcus Staphylococcus spp.	10 3 -10 4
Streptococci Streptococcus spp.	10 4 -10 5
Enterobacteriaceae	10 3 -10 4
Bacteroides spp.	10 3 -10 4
Prevotella spp.	Up to 10 4
Porphyromonas Porphyromonas spp.	Up to 10 3
Fusobacterium Fusobacterium spp.	Up to 10 3
Veilonella spp.	Up to 10 3
Mycoplasma M.hominis	Up to 10 3
Ureaplasma U.urealyticum	10 3
Candida - yeast-like fungi	10 4

Abbreviation CFU/ml means - colony-forming units in 1 ml of nutrient medium. Each colony-forming unit is a microorganism from which a colony can form.

The number of bacteria is expressed in decimal logarithms, in order not to write numbers with a lot of zeros.

In the description of vaginal microflora one can often find the names gram-positive or gram-negative bacteria. These terms mean that the first bacteria are stained according to the method developed by the microbiologist Gram, while the others do not change their color.

Gram-positive rods in a smear, which include lactobacilli, are a good sign. Normally they predominate in women reproductive age. During menopause (menopause) and postmenopause, gram-negative bacteria come first.

Depending on their oxygen demand, bacteria are divided into

aerobic- those that develop in the presence of oxygen;
anaerobic- which do not require oxygen to function.

In the vagina of a healthy woman, most bacteria are anaerobes 10 8 -10 9

CFU/ml.

How to make a smear on the vaginal microflora?

A smear is taken in the gynecologist's office. A woman can also undergo this test in a private laboratory.

The procedure includes several stages.

The woman is placed in a gynecological chair.
Insertion of sterile speculum to gain access to the vaginal walls and cervix.
Collection of material from back wall vagina. This procedure is absolutely painless. Unpleasant sensations can only occur when the spatula touches inflamed area.
Applying material to a glass slide. Vaginal secretion spread with streaking movements over the skim glass in the thinnest possible layer so that the cells are arranged in one row and do not cover each other.
Fixation of the smear is necessary if it is delivered to the laboratory after more than 3 hours. The treatment avoids cell deformation during drying and makes it possible to preserve the drug.
Smear staining using the Gram method. Methylene blue is used as a dye. After staining, it is easier to establish the type of bacteria and determine the composition of the microflora.
Evaluation of the result, which consists of 3 parts: counting leukocytes, species composition of microflora, assessment of vaginal cleanliness.

Often, a smear is taken from three points at once:

openings of the urethra and paraurethral passages (narrow canals located parallel to the urethra);
vaginal walls;
cervical canal.

The anatomical proximity of these areas leads to the fact that infections and inflammations occur interconnectedly. For each area, use a separate sterile spatula, brush or cotton swab. The taken material is applied to 3 sterile glass slides, separately for each area.
A vaginal flora smear is an absolutely harmless procedure that is allowed, including for pregnant women. During the collection of material, the mucous membrane is not injured, so there are no restrictions after the procedure. It is allowed to take a bath, swim, have sexual intercourse, etc.

How to prepare for this smear?

It is necessary to take a smear for flora no earlier than 3 days after the end of menstruation. Menstrual blood cells in the smear can interfere with the results. The optimal period is considered to be from the 10th to the 20th day of the cycle.
The result of the analysis will be as reliable as possible if you adhere to the following rules.

stop taking antibiotics and antifungal drugs 14 days before;
2 days in advance, stop administering any vaginal forms of drugs - solutions, suppositories, tablets, tampons, ointments, creams;
abstain from sexual intercourse for 2-3 days;
Before the procedure, you should not douche or wash the inside of the vagina.

What does a smear show on the vaginal microflora?

A smear on the vaginal microflora shows the presence of a number of diseases and pathological conditions.

Sexually transmitted infections (sexually transmitted infections). They are evidenced by the presence in the smear of a significant number of ureaplasmas, mycoplasmas, gardenella, gonococci, trichomonas and other pathogenic bacteria.
Inflammation vagina(vaginitis, colpitis) or cervical canal(cervicitis and endocervicitis). Evidence of the inflammatory process is a large number of leukocytes in the smear.
Vaginal dysbiosis. Violation of the composition of microflora contributes to the development of diseases of the genital area. Dysbacteriosis is diagnosed when the number of lactobacilli decreases and other types of microorganisms begin to predominate.
Candidiasis or thrush. Normally, single fungi of the genus Candida are acceptable. At fungal infection their number increases sharply, pseudomycelium is found in the smear - threads of elongated cells and bud cells sitting on them.

The flora smear evaluates the following indicators:

4 degrees of vaginal cleanliness

Degree	Identified changes	What is he talking about?
I	The environment is acidic. Leukocytes - up to 10. Epithelial cells - 5-10. Most microorganisms are lactobacilli (Dederlein bacilli). Other bacteria - sporadically. Mucus - a small amount.	Ideal state of vaginal microflora. It is extremely rare in women of childbearing age who are sexually active.
II	The environment is slightly acidic. Leukocytes - up to 10. Epithelial cells 5-10. Most are Dederlein sticks. Gram-positive cocci in small numbers. Small amounts of mucus.	Normal condition. Occurs in most healthy women.
III	The environment is neutral. Leukocytes - over 10. Epithelial cells - over 10. Microorganisms in moderate or large quantities. Gram-negative and gram-negative rods and cocci are present. Single Dederlein sticks. "Key" cells are present. Mucus - moderate amount.	Inflammation of the vagina - colpitis. Symptoms may occur: creamy vaginal discharge, itching, burning, discomfort during sexual intercourse. Some women are asymptomatic with this condition.
IV	The medium is neutral or alkaline, pH over 4.5. Leukocytes - over 30 or the entire field of view. Epithelial cells - in large numbers. Microorganisms in massive quantities. The microflora is represented by various opportunistic and pathogenic microorganisms. Dederlein's rods may be absent. There is a lot of mucus.	Severe inflammatory process. Symptoms: copious discharge from the vagina (white, yellowish, greenish), often with unpleasant smell. Itching, burning, dryness, discomfort. Unpleasant sensations, pain during sexual intercourse.

What is the norm for a smear on the vaginal microflora?

In smear microscopy for flora, the following is considered normal:

flat cells of the vaginal epithelium - up to 10 in the field of view;
single leukocytes - up to 10 in the field of view;
cells of the intermediate layer are single;
“false key” cells - rare;
total quantity microorganisms “moderate”, sometimes “large”;
mucus - in small quantities;
Lactobacilli predominate among bacteria; other types of microorganisms are rare and rare.

The smear should not contain:

Large numbers of destroyed epithelial cells. This indicates cell lysis, which occurs with abnormal growth of lactobacilli.
Key cells . These are epithelial cells covered various bacteria.
Parabasal cells. Cells of the lower layers of the mucosa. Their appearance indicates significant inflammation or atrophy of the mucosa.
"Massive" amount of bacteria, except lactobacilli.
Yeast cells with pseudomycelium and blastopores (bud cells). Their presence indicates thrush.
Strict anaerobes - most of them are pathogens.
Gonococcus - pathogens of gonorrhea.
Trichomonas - causative agents of trichomoniasis.
Atypical cells which are a sign of precancerous or oncological changes .

Some microorganisms (chlamydia, various viruses) are not detected when examined under a microscope due to their small size. To identify them, a blood test for ROC is necessary.

What do leukocytes indicate in a smear on vaginal flora?

Leukocytes- These are white blood cells that are designed to fight infection. They can exit through the wall of blood vessels and move independently. Leukocytes have the ability to phagocytose - they engulf bacteria and digest them. Once the bacterium is digested, the white blood cell is destroyed. This releases substances that cause inflammation, manifested by swelling and redness of the mucous membrane.
Normally, the number of leukocytes in the vagina should not exceed 10. A large number of leukocytes indicates inflammation. The higher the number of leukocytes, the more pronounced the inflammatory process.

Why is sensitivity to antibiotics performed when examining a smear?

Antibiotic sensitivity or antibiogram- determining the sensitivity of bacteria to antibiotics. The study is carried out simultaneously with smear culture if pathogenic bacteria are detected in the vagina, causing inflammation or sexually transmitted infections.

There are a large number of antibiotics, but not all of them are equally effective against different groups bacteria (antibiotics do not affect viruses). It happens that after a course of antibiotics the patient does not recover or the disease returns after a few days/weeks. This happened because antibiotics that had little effect on the causative agent of the disease were prescribed for treatment.
In order for treatment to be as effective as possible, it is necessary to determine which antibiotics:

completely destroy the bacteria that causes the disease;
stop the growth of the pathogen;
do not affect the life activity of this bacterium.

Based on the research carried out, a antibiogram. This is a list of antibiotics to which bacteria are sensitive.

How is antibiotic sensitivity testing performed?

After the bacteria that caused the disease have been identified, they are distributed into several test tubes with nutrient media. A specific antibiotic is added to each tube. The test tubes are placed in a thermostat, where optimal conditions are created for their reproduction.

After cultivation (about 7 days), the growth of bacteria in test tubes is analyzed. Where bacteria are sensitive to the antibiotic, colonies do not form. This drug is optimal for treating the patient. In a test tube where drugs to which antibiotics are insensitive are added, the growth of bacteria is the most intense. Such medicines cannot be used to treat this disease.

What is smear culture?

Smear culture or bacteriological culture(bacteria culture) smear is a laboratory test in which the contents of the vagina are placed in a nutrient medium and optimal conditions are created for the growth of bacteria.

Objectives of the study:

identify the causative agent of genital infection;
establish the degree of contamination - the number of bacteria in the vagina;
monitor the state of microflora after long-term treatment antibiotics, cytotoxic drugs. It is carried out 7-10 days after discontinuation of the drug.

In what case is smear culture prescribed?

to all pregnant women upon registration;
at inflammatory processes in the genitals;
Gram-negative diplococci were found in the smear - for confirmation gonococcal infection(gonorrhea);
with vulvovaginitis, recurrent or chronic.

How is microbiological testing performed?

Vaginal discharge is placed in nutrient media - solutions or jelly-like masses that contain nutrients for bacteria. Test tubes and Petri dishes are placed in a thermostat for 3-5 days, where the temperature is constantly maintained at about 37 degrees, optimal for the proliferation of microorganisms.

After cultivation, the laboratory assistant evaluates the results. From each microorganism, during the process of division, a whole colony of bacteria grows. According to her appearance The laboratory technician determines the type of pathogen. And by the number of colonies one can judge the concentration of these microorganisms in the vagina. Next, the concentration is compared with normal indicators.
Those bacteria whose concentration exceeds 10 4 CFU/ml are considered significant. At this concentration, microorganisms can cause disease. If such a quantity of bacteria is detected, the result of the analysis is considered positive.

The conclusion issued by the laboratory states:

view microorganism that predominates in the smear;
pathogenicity microorganism - ability to cause disease:

Pathogenic - the presence of which can only be caused by disease.
Opportunistic - bacteria that cause disease only when immunity decreases, with a significant increase in their number.

concentration microorganism in the vagina. In numerical terms and in the form of verbal characteristics: “meager”, “moderate growth”, “abundant growth”.

In a laboratory report, the number and growth of bacteria can be characterized by the degree of:

Degree	Features of bacterial growth
Degree	Liquid culture medium	Dense nutrient medium
I	Growth is very poor.	There is no bacterial growth.
II	Moderate growth	Up to 10 bacterial colonies.
III	Abundant growth.	From 10 to 100 colonies.
IV	Massive growth.	Over 100 colonies.

I degree is the norm. In degree II, they speak of a violation of the vaginal microflora. III-IV degrees indicate a disease caused by this type of bacteria.

Women, unlike men, have to visit a doctor more often to treat the genitourinary system. So, during pregnancy, the expectant mother should regularly visit the gynecologist and undergo some tests. When applying for a job or educational institution, they now also require a gynecologist's opinion. In this article we'll talk about what leukocytes are in a smear. The norm for the content of these bodies will also be indicated below. You will learn why a smear is taken for flora and how this procedure goes.

Vaginal smear

This test is taken at every visit to the doctor. It is worth noting that the study is carried out quite simply and quickly, but nevertheless it can say a lot about the state of the female reproductive system. That is why gynecologists primarily prescribe this test.

How is a flora smear done?

A smear is taken at least three times during pregnancy (the norm of leukocytes will be indicated below). If there are any deviations and treatment is required, then reanalysis always taken a few weeks after a course of drug therapy.

The analysis is very simple. The woman is asked to sit on the gynecological chair and relax. The doctor inserts a speculum into the vagina and takes material from the cervix, from the walls of the vagina and from the urethra. When deciphering the result, the place from which the material was collected must be taken into account.

Duration of the study and data obtained

A smear on the flora is examined quite quickly. You will receive your results within one or two business days. Remember that it is the doctor who must decipher them. Surely a woman will not be able to understand all the data and correctly interpret the conclusion on her own.

Typically, the result always indicates the names of the elements being examined and the resulting value. Thus, the number of leukocytes and the condition of the epithelium must be determined. The analysis examines the presence or absence of cocci and trichomoniasis pathogens.

Further studies are more detailed. They are carried out only when necessary.

Leukocytes in smear: normal

After receiving the result, you can confidently draw a conclusion about the state of the woman’s reproductive system. When deciphering, it is necessary to take into account the day of the cycle, the presence of pregnancy and colds. So, what is the norm of leukocytes in a smear for representatives of the fairer sex?

Typically, the number of white cells in the field of view should not exceed 10. So, if the analysis says that single leukocytes were detected, the smear is “normal.” In women who have just finished menstruating, the number of these cells may be slightly higher. In this case, it does not exceed 25 units in the field of view. These data are also considered absolutely normal. However, it is worth warning your doctor in advance about your recent menstruation.

In expectant mothers, the level of white cells may also be increased. If you are expecting a child and have had a smear for flora, the norm allows for leukocytes in an amount of no more than 30 units per field of view. This applies to all sites from which material was collected.

If there is a viral or bacterial disease the level of white cells may increase slightly. Moreover, the more acute the infection, the higher the value obtained. That is why doctors do not recommend taking a smear for flora during illness. If there is no other way out, then you need to warn the doctor about the existing pathology.

Degree of vaginal cleanliness

After receiving the result, you can make a preliminary conclusion. Most often, doctors classify the fairer sex according to the degree of vaginal cleanliness. This classification directly depends on the number of leukocytes and other impurities. So, if leukocytes are found in a smear, is this normal or pathological?

First degree

In this case, the result of the analysis is the following data. Leukocytes are detected in the amount of several units in the field of view. The microflora is represented by beneficial bacteria. There are no cocci, pathological mucus and Trichomonas. The conclusion will indicate: smear analysis (leukocytes) is “normal”.

Second degree

There are also single cells of white bodies in the field of view. However, beneficial microflora is represented along with cocci and yeast fungi. Usually, in the absence of complaints of itching and unusual discharge, a woman is considered absolutely healthy. However, if there is unpleasant symptoms, then minor treatment is required. If such microflora is found in expectant mother, then she is prescribed therapy without certain symptoms.

Third degree

In this case, the result of the analysis may be the following data: the number of leukocytes exceeds the norm (more than 30 cells in the field of view), cocci, yeast and other pathogens are present. This result is always considered a deviation from the norm. The woman is prescribed treatment.

Fourth degree

This is the most last step. In this analysis, a large number of leukocytes are present. Beneficial microflora depleted, pathogenic bacteria and microorganisms are revealed. When obtaining such a result, it is necessary additional diagnostics, after which the woman is prescribed appropriate treatment.

Leukocytes in a smear: deviations

If you took a smear for flora and a large number of leukocytes were found in it, then this is a deviation. In this case, the woman is prescribed a number of additional tests. In this case, it is necessary to take into account the presence of a permanent sexual partner and the method of protection. If a representative of the fair sex is not “friendly” with such a means of protection as condoms, then there is a possibility of an infection that is transmitted through sexual contact.

So, if the level of leukocytes increases, it is recommended to undergo a detailed analysis of the flora, conduct research for the presence of sexual diseases, and also do bacterial culture. After receiving the results, you can talk about the diagnosis and prescribe treatment. What can cause an increase in the level of leukocytes in a smear?

Bacterial infections acquired through sexual contact (mycoplasma, trichomonas, chlamydia, gonorrhea, syphilis and others).
Inflammatory process in the vagina against the background of decreased immunity (with colds, during pregnancy and so on).
Diseases of the uterus and appendages (endometritis, salpingitis, adnexitis).
A decrease in the level of beneficial bacteria against the background of the proliferation of cocci and fungi (thrush, gardnerellosis, and so on).
The development of tumors of a benign or malignant nature.

Conclusion

Now you know what leukocytes are in a smear. The norm is always indicated on the form with the analysis result. If you deviate from it, you should visit a doctor as soon as possible and carry out appropriate treatment. Otherwise you may get serious complications. Get tested on time and be healthy!