A smear on the flora of women is taken for diagnostic purposes; this analysis allows you to detect atypical cells, assess hormonal balance and identify signs of certain gynecological diseases.
Women are prescribed a smear test for preventive purposes, as well as in case of symptoms of diseases of the genitourinary system and in the presence of complaints: itching in the vaginal area, discharge not associated with menstruation, pain in the lower abdomen. Such an analysis is definitely indicated after long-term treatment with antibiotics and during pregnancy planning. The procedure is painless and does not cause harm.
The importance of microflora tests
Analysis of a smear for microflora in women is one of the most rational ways to identify dysbacteriosis, inflammatory and infectious diseases of the female genital area. The advantages of this research method include quick results, cost-effectiveness of diagnosis and its high accuracy. Based on the results of laboratory diagnostics, the gynecologist can determine the further direction of the examination, if he sees the need for it, and prescribe a course of treatment. Thanks to the examination of a smear for microflora, it becomes possible to determine the presence of:
- leukocytes - normally found in single quantities (up to 5 in the vagina and urethra and up to 10 on the cervix). An increase in their number indicates an inflammatory process;
- Doderlein rods - normally predominate over other representatives of the microflora (95–98% of the total);
- squamous epithelium - cells that form the mucous membranes of the internal genital organs. They should occur in moderate quantities in smears taken from the vagina, urethra and cervix;
- mucus is a secretion of the glands, which is normally present in moderate quantities in a smear from the cervix and vagina. There may be no mucus in the urethra
- Gardnerella vaginalis – normally the amount of the microorganism is in the range of 5–37% of the total number of microorganisms;
- Micoplasma hominis – its share should not exceed 30% of the microflora;
- Mobiluncus spp. – normally this microorganism is represented by no more than 5% of the total mass of microorganisms.
Exceeding normal values indicates an imbalance of microflora (vaginal dysbiosis) and/or other infections and requires treatment.
Are bacteria good neighbors or irreconcilable enemies?
After reviewing the results of the study, the doctor can obtain information about the composition of the vaginal microflora, the total number of microbes, the presence and severity of inflammation, and, finally, the condition of the vaginal epithelium.
The microflora of the vagina is the microbes that inhabit it. In the vagina of a healthy woman, beneficial microorganisms predominate. The leading place among them is occupied by lactobacilli, which form a kind of barrier to the spread of pathogenic (disease-causing) microbes. In addition, lactic acid, which is formed during their vital activity, largely determines the acidity (pH) of the vaginal environment. With a sufficient number of lactobacilli, the acidic environment of the vagina suppresses the growth of pathogenic microbes. Under conditions where lactobacilli die, the acidity of the environment decreases and the number of pathogenic bacteria increases.
Side by side with beneficial bacteria live bacteria that have pathogenic properties, but these properties do not have the opportunity to manifest themselves while their beneficial neighbors interfere with this. With normal immunity, as a rule, the various microorganisms that populate the vagina are in a state of truce. When immunity is weakened, favorable conditions are created for expanding the sphere of influence of pathogenic microbes. The vaginal microflora reacts sensitively to both external and internal changes occurring in a woman’s body. The use of antibiotics, hormonal fluctuations, chemotherapy or hormonal therapy, radiation therapy, surgery, stressful situations and other factors can have a negative impact on the normal flora of the vagina. Pregnancy also affects the vaginal microflora, since during this period hormonal levels and immunity change significantly. These changes reach their peak in the third trimester. Therefore, it is during this period that women are very often concerned about the symptoms of inflammation discussed above. Most often, the cause of this condition during pregnancy is the yeast-like fungus Candida albicans, and the disease itself is called candidiasis, candidomycosis, or simply thrush.
The fungus Candida albicans lives on the skin and mucous membranes of any person, but it is activated only when the immune system is weakened or the bacteria that inhibit its proliferation, including lactobacilli, die. Thrush manifests itself as signs of inflammation and a milky-white coating on the mucous membrane; this coating resembles grains of cottage cheese or the remains of dairy food.
Degrees of vaginal cleanliness
When deciphering a smear for flora, much attention should be paid to indicators of cleanliness, which reflect the general condition of the genital organs.
I. _ Acidic reaction (pH 3.8–4.5). This means that a large proportion of microorganisms are lactobacilli (or Doderlein bacilli). Leukocytes and epithelial cells may be present in small quantities. This result indicates excellent reproductive system health.
II . Acidic reaction (pH 4.5–5.0). In this case, the microflora is represented mainly by lactobacilli, but gram-negative bacteria are also found.
III . Alkaline or slightly acidic reaction (pH 5.0–7.0). The smear reveals only a small amount of lactobacilli; bacterial flora and a large number of epithelial cells predominate.
IV . Alkaline reaction (pH 7.0–7.5). There are no Doderlein bacilli in the smear, the microflora is represented by pathogenic microorganisms, and there is a large number of leukocytes. This degree of cleanliness indicates inflammation of the vaginal mucosa.
Complexes with this research
Women's check-up No. 2 Preventive examination of the urogenital tract 5,140 ₽ Composition
Pregnancy planning. Cervical screening and STIs RUB 3,450 Composition
Entry into IVF Examination when a woman enters the IVF procedure 16,590 ₽ Composition
IN OTHER COMPLEXES
- Examination during pregnancy. 1st trimester 11,430 RUR
- Women's safety RUB 1,640
- Women's reproductive health RUB 2,780
- Examination during pregnancy. 3rd trimester 6,310 RUR
What is reflected in the test results
Microflora culture analysis gives an accurate idea of the quantitative and qualitative composition of the vaginal microflora. Depending on the laboratory in which the research is carried out, the results may reflect different indicators. Among them:
- detection of pathogenic microorganisms that should not normally be present, which makes it possible to diagnose an infectious disease;
- an increase in the number of any type of bacteria that are normally present in the microflora, but in lower concentrations (which indicates dysbiosis);
- determination of an antibacterial and/or antifungal drug to which a pathogenic or opportunistic microorganism is most sensitive.
Antibiotic sensitivity testing
Antibiotics are highly effective medications. But, unfortunately, they have many side effects. One of them is that this type of medicine destroys both pathogenic bacteria and necessary microorganisms. Sometimes treatment gives a paradoxical result. The beneficial microflora is literally emasculated, and the provoking factor (pathogen) does not react due to its resistance to this particular type of antibiotic.
Experts classify pathogens as follows:
- Sustainable. Practically does not respond even to increased doses of antibiotics.
- Conditionally stable. Requires an increase in the dose of the drug.
- Sensitive. Easily suppressed with the right drug.
Different types of antibiotics cause different reactions in microorganisms. After all, the microflora of patients is strictly individual. Prescribed antibacterial therapy can show positive dynamics if the drug is “able” to cope with the root cause of the disease. Antibiotic sensitivity testing is performed precisely for this purpose.
It is carried out if necessary:
- Choose the most effective drug.
- Prevent bacteria from getting used to it. This is necessary if repeated antibiotic therapy is required in one short period.
Resistance testing is also relevant if the patient is allergic to the prescribed medication. In this case, the attending physician must accurately anticipate the possible consequences when replacing the drug.
The test material used is smears from the urethra or vagina. The doctor may also give you a referral to donate stool and urine.
This study is a cultural one, so experts call it sowing. It is really strictly for the duration of illness and before starting antibiotics. The treatment performed may affect the degree of sensitivity of pathogenic microorganisms. If therapy is successful, but over time the patient becomes ill again, the test is ordered again.
If a flora smear shows dysbiosis
The modern drug LACTONORM® refers to medications intended to restore the disturbed balance of vaginal microflora. The live lactobacilli contained in it are not treated with preservatives, which ensures high activity and viability of the cultures. The inclusion of lactose in the composition of the drug Lactonorm® helps to create a nutrient medium for lactobacilli directly in the vagina, which accelerates the colonization of the mucous membrane by beneficial microorganisms.
The use of Lactonorm® should be agreed with your doctor.
Prevention of deviations from the norm
Prevention of inflammation in the female genital area includes the following recommendations:
- refusal of irrational (without consulting a doctor) use of antibiotics, antiseptics and antifungal drugs;
- timely treatment of genitourinary infections;
- using a condom for any type of sex, especially when changing sexual partners frequently;
- restoration of the menstrual cycle in case of disruption;
- proper use of tampons, pads, menstrual cups;
- regular adherence to the rules of intimate hygiene, including the selection of gentle means for washing together with the gynecologist;
- refusal of douching, vaginal douches, spermicides;
- timely replacement of intrauterine devices for contraception;
- taking a hygienic shower (applies to both partners) before sex;
- regular care of intimate devices, as well as their timely disposal;
- refusal of excessively hot baths, insertion of foreign objects into the vagina, visits to bodies of water of questionable cleanliness;
- limiting alcohol consumption and cigarette smoking.
Important!
Women who receive long-term immunosuppressive therapy (hormones, cytostatics, antibiotics, radiation therapy) need to visit a gynecologist more often. Taking any medications that affect local or general immunity should be agreed with your doctor.
Sources
- Textbook: Atlas on the technique of performing gynecological manipulations and operations / comp.: T.F. Tikhonova, I.V. Sakhautdinova, E.M. Zulkarneeva, S.U. Hamadyanova, A.D. Maroon. - Ufa: Federal State Budgetary Educational Institution of Higher Education BSMU, 2021. - 93 p.: ill.
- Regushevsky S.E., Khomulenko I.A., Beglitse D.A., Demidova N.S., Bagrova G.N. Research methods in obstetrics and gynecology. Textbook / Ed. Professor Rybalka A.N. Simferopol. 2016.
- Pestrikova T.Yu., Yurasova E.A., Kotelnikova A.V. Vulvovaginal candidiasis: a modern view of the problem // Breast cancer. Mother and child. 2017;25(26).
- Savitskaya V.M. Practical guide to obstetrics: educational and methodological manual / V.M. Savitskaya. - Minsk: BSMU, 2021. - 47 p.
- Pestrikova T.Yu., Yurasova E.A., Kotelnikova A.V., Knyazeva T.P. Modern approaches to verification of the diagnosis of bacterial vaginosis and management tactics // Breast Cancer. Mother and child. 2018;26(2(I)):48-53.
- Guide to outpatient care in obstetrics and gynecology / Ed. Serova V.N., Sukhikh G.T., Prilepskoy V.N., Radzinsky V.E. — 3rd ed., revised. and additional - M.: GEOTAR-Media, 2016. - 1136 p. — ISBN 978-5-9704-4004-9.
- Ministry of Health of the Russian Federation. Order No. 1130n dated October 20, 2021 “On approval of the Procedure for the provision of medical care in the field of obstetrics and gynecology.”
- Kurashvili L.V., Tyazhelkova G.V., Dolgusheva M.V., Korobovtseva T.N., Mikulyak N.I. The role of opportunistic microflora in the mechanisms of development of female and male infertility // News of universities. Volga region. Medical Sciences. 2021. No. 4 (56).
