The amount of microflora is abundant which means. Mixed flora in a smear: what does the imbalance of microorganisms indicate? What can be found in a smear

smear on flora- an analysis often prescribed by gynecologists. What does it show and what misconceptions exist about it?

This analysis can be called "general". This is the primary diagnosis, which allows the doctor to confirm or refute the presence of an inflammatory process in the vagina, urethra, cervical canal, as well as draw certain conclusions regarding the possible menopause or menopausal changes in the patient.

What is the name of the analysis:

• microscopic (bacterioscopic) examination of a Gram-stained smear is the official name;
• swab from the genitals;
• bacterioscopy;
• microscopy.

Used to diagnose infectious and inflammatory processes. Bacterioscopy allows you to detect bacteria in the genitals of a woman: the simplest microorganisms - gonococci, which provoke gonorrhea, Trichomonas - the causative agent of trichomoniasis. Also, a specialist in a microscope will see some bacteria, fungi (Candida), key cells (a sign of bacterial vaginosis). The type of microorganism is determined by the shape, size, and whether it is stained with a dye or not, that is, it is gram-positive or gram-negative.

In addition, in a smear from each point (taken from the vagina, urethra, cervical canal), the number of leukocytes in the field of view is counted. The more of them, the more pronounced the inflammatory process. The amount of epithelium and mucus is estimated. especially a lot in women of reproductive age during ovulation - in the middle of the menstrual cycle.

Microscopic examination of the discharge of female genital organs is an opportunity to quickly assess whether a woman is gynecologically healthy or not and make one of four diagnoses:

• vaginal candidiasis (thrush);
• bacterial vaginosis (formerly called gardnerellosis);
• gonorrhea;
• trichomoniasis.

If there are no clear signs of one of these diseases, but the smear is bad, an in-depth study of the material is carried out - bacteriological culture is performed.

Reasons for performing cultures in gynecology

1. If the smear has a moderate or high number of leukocytes, but the causative agent of the infection is not known. Since under microscopy there is a lower limit of detection of microorganisms: 10 to 4 - 10 to 5 degrees.
2. If the microbe is identified, to determine its sensitivity to antibiotics.
3. If there are signs of a fungal infection. To accurately establish the type of fungi and prescribe an effective antimycotic drug.

   Some types of fungi, such as Candida albicans (Candida albicans - a diploid fungus), are very dangerous for expectant mothers and can provoke infection and premature rupture of the membranes.

   Other types of Candida fungi can be left untreated if there are no pathological symptoms.

If key cells are found (signs of bacterial vaginosis), but other microbes are present in addition to them. For identification.

What is the difference between culture, flora smear and vaginal cleanliness

in the research method. With a general smear, the material applied to the glass is stained with special dyes and viewed under a microscope. And when they do a bacteriological (bacteriological, cultural, microbiological) study, then it is first “sown” on a nutrient medium. And then, after a few days, they look under a microscope - colonies of which microorganisms have grown.

That is, if we are talking about express analysis, you will be given a conclusion only on the number of leukocytes, epithelium and mucus. Sowing is not urgent

Also, with microscopy, you can quickly determine the degree of purity from the vagina. Here the doctor only evaluates the ratio between normal, opportunistic and pathogenic microflora.

The classic assessment of vaginal cleanliness.

Updated table

What doctors don't see on microscopy

1. Pregnancy. To determine it, a smear is not needed and no matter what result it will show. It is necessary to take a blood test for hCG, undergo a gynecological examination with a doctor or do an ultrasound of the uterus. You can determine the chorionic gonadotropin in the urine, but not in the discharge from the genitals!
2. Cancer of the uterus and cervix. To diagnose a malignant degeneration of the endometrium, histological material is needed, and in large quantities. And they take it directly from the uterus.

   CC and other pathologies (erosion, leukoplakia, atypical cells, etc.) are determined according to the results of a cytological study. This analysis is taken directly from the cervix, from the transformation zone, according to a certain technique with Papanicolaou staining (hence the name of the analysis - PAP test). It is also called oncocytology.

3. Does not show infections (STDs) such as:
   • herpes;
   • chlamydia (chlamydia);
   • mycoplasmas (mycoplasmosis);
   • ureaplasma (ureaplasmosis);

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

How to prepare for the test and when it is needed

The doctor takes a smear from the patient on the gynecological chair (regardless of whether she is pregnant or not) using a special brush or a sterile Volkmann spoon. It doesn't hurt at all and is very fast.

It is technically possible to achieve a good, even perfect smear, if you sanitize the vagina with chlorhexidine or miramistin, for example. But what's the point?

To get a reliable smear result, 48 hours before it is taken, you cannot:

• douche;
• have sex;
• use any vaginal hygiene products, intimate deodorants, as well as medications, if they have not been prescribed by a doctor;
• do an ultrasound using a vaginal probe;
• undergo a colposcopy.
• before visiting the gynecologist or laboratory, 3 hours, you should not urinate.

Pap smears should be taken outside of menstrual bleeding. Even if there is just a “daub” on the last day of menstruation, it is better to postpone the study, since the result will certainly be bad - a large number of leukocytes will be revealed.

There are no restrictions on drinking alcohol.

Can I take a smear while taking antibiotics or immediately after treatment? It is undesirable to do this within 10 days after using topical drugs (vaginal) and one month after taking antibacterial agents inside.

Microscopic examination is prescribed:

• in a planned manner when visiting a gynecologist;
• upon admission to the gynecological hospital;
• before IVF;
• during pregnancy (especially if there is often a bad smear);
• if there are complaints: unusual discharge, itching, pelvic pain, etc.

Deciphering the results: what is considered the norm, and what is the pathology in the microflora

To begin with, we bring to your attention a table that displays the indicators of the so-called first degree of purity. There is no mention of the urethra in it (although the material is also taken from there), since we are talking about gynecological diseases. The inflammatory process in the urethra is treated by a urologist.

Epithelium - the number of epithelial cells is not counted, as it has no diagnostic value. But too little epithelium indicates an atrophic type of smear - it happens in women during menopause.

Leukocytes - are considered in the "field of view":

• no more than 10 - a small amount;
• 10-15 - a moderate amount;
• 30-50 - a large number, a woman notices pathological symptoms, and the doctor, upon examination, diagnoses an inflammatory process in the vagina and (or) on the cervix.

Mucus (strands of mucus)- normally should be present, but a large amount of it happens with inflammation. There should be no mucus in the urethra.

Rod flora or gr lactomorphotypes- the norm, this is the protection of the vagina from microbes.

Trichomonas, gonococci and key cells a healthy woman should not have it in the cervix and vagina. Candida is also normally absent. At least in a significant amount, which is detected in the analysis of the flora.

The validity of the smear is not great. But if a woman enters a hospital, then right there, during the initial examination on the chair, they take a fresh one.

Usually the results are valid for 7-14 days. Therefore, if you need to take it before the operation, do it 3 days before admission to the hospital. The last of the scheduled tests.

What is found in bakposeve

A gynecologist can best decipher the result of a cultural study. But you yourself, if you read the information below, will roughly understand your analysis.

The number of microorganisms can be expressed in "crosses":

• "+" - a small amount;
• "++" - a moderate amount;
• "+++" - a large number;
• "++++" - abundant flora.

But more often the number of representatives of the microflora is expressed in degrees. For example: Klebsiella: 10 to the 4th power. By the way, this is one of the representatives of enterobacteria. Gram-negative bacillus, aerobic microorganism. One of the most dangerous pathogens, although it is only conditionally pathogenic. This is because Klebsiella is resistant (immune) to most antibacterial agents.

Below we describe other common terms that appear in the results of the study, or you may hear from a doctor.

Soor is candidiasis or, in other words, thrush. It is treated with antimycotic (antifungal) drugs.

Blastospores and pseudomycelium of yeast-like fungi- candidiasis or other fungal disease, usually treated similarly to thrush.

Diphtheroids are conditionally pathogenic microorganisms, according to the results of research by scientists, in most women, about 10% of the microflora is made up of them, as well as streptococci, staphylococci, E. coli, gardnerella. If the flora is disturbed, their number increases.

Mixed flora - a variant of the norm, if there are no symptoms of the disease, completely leukocytes or their strong increase (40-60-100). 15-20 is a variant of the norm, especially during pregnancy.

Enterococci (Enterococcus)- representatives of the intestinal microflora, which sometimes enter the vagina. Gram-positive cocci. About Enterococcus fecalis (Enterococcus faecalis) we. There is also enterococcus coli - Escherichia coli. Usually cause unpleasant symptoms at concentrations above 10 to the 4th degree.

Pseudomonas aeruginosa is a Gram-negative bacterium. Often affects people with low immunity. It has good resistance to antibiotics, which makes the treatment process difficult.

polymorphic bacillus- a common representative of the vaginal biocenosis. If the number of leukocytes is normal and there are no complaints, its presence should not disturb.

Erythrocytes - may be in a small amount in a smear, especially if it was taken during an inflammatory process or when there was a small spotting.

Coccal or coccobacillary flora- usually occurs with an infectious process in the vagina or on the cervix. If a woman has complaints, antibacterial treatment is required - sanitation of the vagina.

Diplococci are a type of bacteria (cocci). Small amounts are not harmful. With the exception of gonococci - the causative agents of gonorrhea. She is always treated.

And in conclusion, we give frequent abbreviations that are written on the forms of test results:

• L - leukocytes;
• Ep - epithelium;
• Pl. ep. - squamous epithelium;
• Gn (gn) - gonococcus, the causative agent of gonorrhea;
• Trich - Trichomonas, the causative agent of trichomoniasis.

Smear on flora in women- a laboratory test that determines the types of bacteria that are present in the vagina. This is the most common and easiest method for detecting inflammation and STDs (sexually transmitted diseases).

The examination is absolutely painless. It is performed during a routine 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 secret) is applied to the glass. In the laboratory, the material is stained so that the bacteria become clearly distinguishable.

Purpose of the study

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

When does a gynecologist take a swab for flora?

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

Normal microflora of the vagina

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

Microorganisms that make up the microflora of a healthy woman

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

In the description of the vaginal microflora, one can often find 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 others do not change their color.

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

Based on their need for oxygen, bacteria are divided into

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

cfu/ml

How to make a smear on the microflora of the vagina?

The procedure includes several steps.

1. The woman is placed in a gynecological chair.
2. Insertion of sterile speculum to gain access to the walls of the vagina and cervix.
3. Collection of material from the posterior wall of the vagina. This procedure is absolutely painless. Unpleasant sensations can occur only when the spatula touches the inflamed area.
4. Applying material to a glass slide. The vaginal secret is distributed with dashed movements on a skimmed glass as thin as possible so that the cells are arranged in one row and do not cover each other.
5. Fixation of the smear is necessary if it is delivered to the laboratory after more than 3 hours. Processing avoids cell deformation during drying and makes it possible to preserve the drug.
6. Gram smear staining. 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.
7. Evaluation of the result, which consists of 3 parts: count of leukocytes, species composition of microflora, assessment of the purity of the vagina.

• openings of the urethra and paraurethral passages (narrow channels located parallel to the urethra);
• the walls of the vagina;
• cervical canal.

How to prepare for this smear?

• stop taking antibiotics and antifungal drugs within 14 days;
• 2 days to stop the introduction of any vaginal forms of drugs - solutions, suppositories, tablets, tampons, ointments, creams;
• refrain from sexual intercourse for 2-3 days;
• before the procedure, you can not douche and wash inside the vagina.

What does a smear show for the microflora of the vagina?

• Sexual 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.
• Dysbacteriosis of the vagina. Violation of the composition of the 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. With a fungal infection, their number increases sharply, a pseudomycelium is found in the smear - threads of elongated cells and kidney cells sitting on them.

4 degrees of vaginal purity

What is the norm of a smear on the microflora of the vagina?

• 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 - single;
• "False key" cells - rarely;
• the total number of microorganisms is "moderate", sometimes "large";
• mucus - in a small amount;
• among bacteria, lactobacilli predominate, other types of microorganisms are single, rare.

• Destroyed epithelial cells in large numbers. This indicates cell lysis, which occurs with abnormal growth of lactobacilli.
• key cells. These are epithelial cells covered with 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 for lactobacilli.
• Yeast cells with pseudomycelium and blastopores (kidney 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 .

What do white blood cells say in a smear on the vaginal flora?

Why is antibiotic susceptibility done in a smear test?

Sensitivity to antibiotics

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

• completely destroy the bacterium - the causative agent of the disease;
• stop the growth of the pathogen;
• do not affect the activity of this bacterium.

How is antibiotic susceptibility testing done?

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

What is a smear culture?

Research objectives:

• determine the causative agent of infection of the genital organs;
• establish the degree of contamination - the number of bacteria in the vagina;
• control the state of the microflora after long-term treatment with antibiotics, cytostatic drugs. It is carried out 7-10 days after the drug is discontinued.

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

How is a microbiological study carried out?

The 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 a temperature of about 37 degrees is constantly maintained, which is optimal for the reproduction of microorganisms.

After cultivation, the laboratory assistant evaluates the results. From each microorganism in the process of division, a whole colony of bacteria grows. By its appearance, the laboratory assistant determines the type of pathogen. And by the number of colonies, one can judge the concentration of these microorganisms in the vagina. Next, the concentration is compared with normal values.
Bacteria whose concentration exceeds 104 cfu/ml are considered significant. At this concentration, microorganisms are capable of causing disease. If such a number of bacteria is detected, the result of the analysis is considered positive.

The conclusion issued by the laboratory states:

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

• Pathogenic - the presence of which can only be caused by a disease.
• Conditionally pathogenic - bacteria that cause disease only with a decrease in immunity, with a significant increase in their numbers.

• concentration microorganism in the vagina. In a numerical indicator and in the form of a verbal characteristic: “scarcely”, “moderate growth”, “abundant growth”.

The attending physician should decipher the smear for flora, but some information can be obtained independently even before admission.

What can a smear on flora tell about?

Let us consider in more detail what the results of the analyzes can be and what it means.

Mixed flora in a smear

Occurs in such cases:

• the beginning or end of the menstrual cycle;
• menopause;
• the presence of sexually transmitted diseases;
• ovarian hyperfunction;
• the onset of puberty in girls.

To determine the exact cause of the presence of mixed flora in a smear, it is necessary to evaluate the number of leukocytes and conduct additional studies.

Rod flora in a smear

Sticks are of two types:

1. Morphotype of lactobacilli (Dederlein sticks).
2. Small sticks.

A lot of sticks of the first type in the flora is a normal indicator of a healthy organism. At the same time, single leukocytes are observed in the field of view or their number does not exceed 10 pieces per square centimeter.

The presence of small sticks indicates a disease such as gardnerellosis or vaginal dysbacteriosis.

Lactobacillary flora in a smear

Lactobacilli are a normal component of a healthy microflora. When deciphering the analysis, it is necessary to pay attention to the concentration of leukocytes and erythrocytes, as well as their ratio with the number of lactobacilli.

Coccobacillary flora in a smear

This result is usually combined with an increased content of leukocytes and the almost complete absence of Dederlein sticks. The discharge from the vagina has a thick mucous structure with an unpleasant odor. Coccobacillary flora occurs in 2 cases:

1. Bacterial vaginosis.
2. Venereal diseases.

Often these causes are interrelated and require specific treatment, sometimes with antibiotics.

Absence of flora in a smear

The result of a study of this type is extremely rare and may mean that before taking a smear, the body was treated with antibacterial drugs in high dosages for a long time. This leads to the extinction of the normal components of the flora, especially lactobacilli, which will have to be restored under the supervision of a doctor.

Smear for pathogenic intestinal flora

This type of analysis is taken either from the vagina or from the rectum. Due to the close relationship between the intestines and the reproductive organs of a woman, as well as their proximity, infectious agents can quickly spread from the vagina to the intestinal walls and vice versa.

Rules for passing a smear on flora:

1. Avoid sexual intercourse two days before taking a smear.
2. Don't take a bath.
3. Do not douche.
4. Do not use vaginal tablets, suppositories and tampons.
5. 3 hours before taking a smear, stop going to the toilet.
6. Before taking the test, you need to wash yourself with exclusively warm water, without hygiene products.
7. Do not take a smear directly during menstruation, as well as at the very beginning and end of the menstrual cycle.

If the swab is taken from the nasopharynx, the rules are as follows:

Dysbiosis is defined as a violation of the microflora of the vaginal environment. If it is not treated, the disease will progress, causing a number of the most negative consequences.

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

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

III degree - it is characterized by opportunistic flora and yeast-like fungi, which tend to actively reproduce. This may indicate the development of an inflammatory reaction to the presence of an excessive number of opportunistic microorganisms.

This analysis involves an additional examination of the woman;

IV degree - signs of an obvious inflammatory process: abundant coccal or cocco-bacillary (mixed) flora, the presence of Trichomonas, gonococci or other pathogenic microorganisms is possible.

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 it is considered a simple method, but 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, therefore it is not recommended to avoid such an accessible procedure.

It does not require a lot of expenses, and the answer will not have to wait long.

Causes of violation of the microflora of the vagina

There are many factors that influence the appearance of dysbiosis:

• Single and constant hypothermia, which reduces immunity and contributes to the development of dysbacteriosis.
• Change in hormonal background. Unsystematic sex life, menopause, pregnancy, childbirth, abortion, menstrual irregularities, etc.
• Change of climatic zones.
• stressful situations.
• Chaotic sex life. Frequent change of sexual partners. Ignoring methods of contraception.
• Inflammatory and infectious diseases small pelvis.
• Infections acquired after sexual intercourse.
• Prolonged antibiotic treatment.
• Intestinal diseases.
• Incorrect insertion and use of menstrual tampons.

All these and other reasons cause a violation of the microflora of the vagina.

What is the degree of purity?

The descriptions of the different degrees of purity are as follows:

1. At first, the health of the vagina indicates its absolute norm. At this degree, about 95% (or more) of lactobacilli, a small number of leukocytes and a few epithelial cells are detected.
2. In the second, the picture is identical to that diagnosed in the first degree, with the only difference being that opportunistic flora is found in the smear, albeit in a small amount.
3. With the third, the situation is so different that opportunistic bacteria begin to prevail, rather than Doderlein's sticks.
4. At the fourth, the epithelium is found (and its content is very high), bacterial microorganisms, leukocytes. Rods are either not detected at all, or there are too few of them.

The degree of purity has a direct impact on the response of the vaginal environment. With the first two, it has an acidic character, and with the latter, it acquires a weak and pronounced alkaline reaction.

Description of the smear in relation to the state of the flora

The presence of individual components in a smear may not so much be a reason for suspicion of a specific disease, but rather serve as the basis for a prognosis, the appointment of a detailed examination of women's health. What can the obtained decrypted data tell about?

Epithelial cells, increasing in number, indicate inflammation.

Such a number of leukocytes, which is characterized, can indicate acute or chronic inflammation.

Mucus in a normal smear can only be detected within the vagina. Its localization in the urethra indicates the onset of inflammation in the urethra.

The coccal flora can ideally be only in the vagina, and then in a small volume. An increase in this indicator describes its pollution, the presence of dysbiosis, inflammation in it.

A clear sign of gonorrhea is the found gonococcus. The presence of pathogens Trichomonas and gardnerella indicates trichomoniasis and gardnerellosis.

An analysis of a smear for flora with a decoding performed is of great value in relation to studying the state of the environment of the female genital organs.

Helps to identify pathologies of dysbacteriosis and infections. It serves as the basis for performing cytomorphological and bacterial studies of secretions.

When identifying 3 and 4 degrees of purity, it is necessary to conduct clarifying studies and, until the circumstances are clarified and a complete cure, to abandon any gynecological manipulations.

At 1 and 2 degrees of purity, the environment in the vagina is acidic and slightly acidic, in the case of 3 and 4 - slightly alkaline and alkaline, respectively.

So, the degree of purity of the vagina can be one of 4 degrees, depending on the results that the smear showed on the flora.

• I degree of purity - characterized by a normal level of leukocytes, a moderate amount of mucus and squamous epithelium in the smear. Pathogenic, as well as conditionally pathogenic flora is absent. The microflora of the vagina is mainly represented by various types of lactobacilli. The first degree of purity of the vagina is ideal, it symbolizes the correct microflora, strong immunity of a woman. It occurs quite rarely.
• 2 degree of purity - the level of leukocytes is still within the normal range, and mucus and epithelium are contained in moderate amounts. However, the flora of the vagina consists not only of lactobacilli, but also of cocci or yeast fungi. This degree of purity of the gynecological smear indicates a decrease in local protection and an increased risk of inflammation. Refers to the norm. The most common variant that is observed in women.
• 3 degree of purity - characterized by an increase in the number of white blood cells (leukocytes), which indicates the presence of an inflammatory process in the woman's body. The composition of the microflora in this case is mainly represented by pathogenic bacteria: yeast, cocci. Lactobacilli in a smear in women are found in small quantities. In the presence of 3 degrees of purity, a woman is required to undergo treatment.
• 4 degree of purity - leukocytes greatly exceed the norm and sometimes cover all fields of view, not giving in to counting. There are no lactobacilli in the smear, and the vaginal flora is represented by pathogenic microbes. The squamous epithelium in the smear and drain are determined in large quantities. This degree of purity is a signal for an emergency start of anti-inflammatory therapy.

Mixed flora in a smear - what is it? What diseases can the analysis tell about? How to properly prepare for research? A mandatory procedure when visiting a gynecologist is a smear. It clearly shows where the inflammatory process is located and which bacteria cause it. An important advantage of this method is the ability to quickly identify pathology. Without a smear, it is simply impossible to determine many diseases. The analysis shows not only the presence of pathogenic microorganisms and fungi, but also their percentage of non-pathogenic ones. The imbalance causes the pH to change from acidic to alkaline. And this is an indicator of the development of infection. The smear is taken by the gynecologist immediately after the examination at each visit. This is important not only for diagnosis, but also for the prevention of diseases. The doctor collects an anamnesis: takes into account complaints, assesses the condition of the genital organs, the presence of non-specific secretions. Then, with a disposable spatula, a fence is made from the urethra, vagina, and cervix. The collected material is spread on a glass slide and sent to the laboratory.

Even healthy women should visit the gynecologist once a year and do a smear. Patients with gynecological diseases and pregnant smears take more often. How to prepare:

• do not pre-use vaginal preparations;
• do not douche;
• within 2 days not to have sexual relations;
• 2 hours before the doctor's appointment, do not urinate;
• wash with water without soap;
• do not take a bath the day before;
• do not come for analysis at the beginning or end of menstruation.

How to read test results?

This is the task of the gynecologist. Sometimes the doctor questions the accuracy of the analysis. In this case, the smear is taken again. It is advisable to be observed by one doctor and take tests in one laboratory. The mixed flora in the vaginal smear consists of epithelial cells, leukocytes, Dederlein rods and other microorganisms. The norm is 95% lactobacilli. They protect against harmful microorganisms and infections. The norm is 5% of opportunistic bacilli and cocci. A small amount of such bacteria (staphylococci) does not harm and does not cause unpleasant symptoms. The percentage offset indicates the degree of purity of the vaginal composition. First degree. The smear contains mucus, the norm of leukocytes, a moderate amount of epithelial cells and most of the lactobacilli. This means that the microflora is normal, healthy immunity, no inflammation.

You should not decipher on your own, but women should know some facts.

Second degree. There is moderate mucus in the smear. Leukocytes are normal. Lactobacilli are present along with cocci and yeast fungi. This is also considered the norm, but there is a risk of inflammatory diseases. The first two degrees show the woman's health. Medical procedures are allowed: biopsy, curettage, surgery. Third degree. Increased amount of epithelium, mucus. Leukocytes exceed normal values. Fourth degree.

A large amount of mucus and epithelium. The level of leukocytes exceeds the norm several times. There are no lactobacilli, the entire microflora is represented by pathogenic bacteria. This indicates an advanced disease. At the last degrees, all gynecological procedures are contraindicated. The doctor prescribes the treatment of inflammation and then a second smear is done. Most of the microflora is made up of pathogenic cocci, yeast fungi. The number of lactobacilli at the minimum values. The inflammatory process has begun. According to the result of the analysis, the doctor determines the microorganism that caused the inflammatory process, and then treatment is already prescribed. Antifungal drugs are used for vaginal candidiasis. If the causative agent is gonococcus, antibiotic therapy will be required.

inflammation

Itching, burning, unusual discharge often accompany two diagnoses. The first of them is colpitis (vaginitis) - a gynecological disease of the vagina caused by Klebsiella, enterobacteria, Escherichia coli, gonococci, hemolytic group streptococcus. The discharge is profuse, the vagina is inflamed. In the smear, the number of leukocytes and macrophages is high. Pathogenic microflora is much higher than the norm.

This is the next suggested diagnosis. Peptococci, peptostreptococci attack here. The symptoms are as follows: mild itching bothers, the burning sensation is not very acute, the discharge is small. But there is a special symptom. It's an unpleasant smell. It intensifies when semen enters the vagina. This is due to the fact that a reaction occurs and volatile amines are released, which smell like rotten fish. Deciphering the microflora shows the complete absence of lactobacilli, cocci and a large number of epithelial cells. Leukocytes are either normal or slightly elevated.

Coccobacillary flora is determined by the high content of leukocytes. Dederlein's sticks are completely absent. The discharge resembles thick mucus with an unpleasant odor. This is bacterial vaginosis or a sexually transmitted disease. If there is no flora in the smear, this indicates that the body has suffered after antibiotic therapy in large dosages. Lactobacilli have died, and treatment will be aimed at restoring the microflora. Flora mixed in a smear happens:

• in sexually mature women who live sexually;
• at the beginning and end of menstruation;
• during menopause;
• with venereal diseases;
• at the beginning of puberty;
• with ovarian hyperfunction.

What bacteria should not be?

In a smear of a healthy woman, there should be no gonococcus. The causative agent is insidious in that in a latent form of the course of the disease it may not manifest itself in symptoms. It can only be detected in the laboratory. There should be no Staphylococcus aureus - the cause of many purulent-inflammatory diseases. Streptococcus is also dangerous for the mucosa. It lives in the large intestine. But when it enters the vagina, it becomes aggressive and can cause miscarriage, premature birth and fetal death. The presence of enterococcus indicates the inflammatory process of the entire genitourinary system. This bacterium lives in the intestines, and this is the norm. But when it enters the ureter, bladder or vagina, inflammation begins. If the analysis is normal, but the woman has signs of any pathology, preventive drugs are prescribed that normalize the balance of beneficial and conditionally pathogenic bacteria.