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 simplest 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).

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

Normal microflora of the vagina

The vagina of a healthy woman is not sterile. It contains many types of microorganisms, their combination is called microflora. Bacteria constantly compete with each other for habitats on the walls of the vagina and for food.

The most numerous are lactobacilli and bifidobacteria, which attach to the 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

Microorganisms	Number of CFU/ml
Lactobacillus or doderlein sticks Lactobacillus spp.	10 7 -10 9
Bifidobacteria Bifidobacterium spp.	10 3 -10 7
Clostridia Clostridium spp.	Up to 10 4
Propionibacterium Propionibacterium spp.	Up to 10 4
Mobiluncus Mobiluncus spp.	Up to 10 4
Peptostreptococcus spp.	10 3 -10 4
Corynebacteria Corynebacterium spp.	10 4 -10 5
Staphylococci Staphylococcus spp.	10 3 -10 4
Streptococcus Streptococcus spp.	10 4 -10 5
Enterobacteria Enterobacteriaceae	10 3 -10 4
Bacteroides spp.	10 3 -10 4
Prevotella Prevotella spp.	Up to 10 4
Porphyromonas Porphyromonas spp.	Up to 10 3
Fusobacteria Fusobacterium spp.	Up to 10 3
Veilonella 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 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.

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

cfu/ml

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

The smear is taken in the gynecologist's office. Also, a woman can undergo this study in a private laboratory.

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: counting of leukocytes, species composition of microflora, assessment of the purity of the vagina.

Often a smear is taken from three points at once:

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

The anatomical proximity of these sites leads to the fact that infections and inflammations are interconnected. For each area, a separate sterile spatula, brush or cotton swab is used. The taken material is applied to 3 sterile glass slides, separately for each area.
A smear on the flora from the vagina is an absolutely harmless procedure that is allowed, including for pregnant women. During the sampling of the material, the mucosa is not injured, so there are no restrictions after the procedure. It is allowed to take a bath, swim, have sex, 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 a smear can skew the results. The period from the 10th to the 20th day of the cycle is considered optimal.
The result of the analysis will be as reliable as possible if the following rules are followed.

• 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?

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

• 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.

In a smear for flora, the following indicators are evaluated:

4 degrees of vaginal purity

Degree	Identified changes	What does he say
I	Wednesday is acidic. Leukocytes - up to 10. Epithelial cells - 5-10. Most microorganisms are lactobacilli (Dederlein sticks). Other bacteria - singly. Slime - a small amount.	The ideal state of the microflora of the vagina. It is extremely rare in women of childbearing age who are sexually active.
II	The medium is slightly acidic. Leukocytes - up to 10. Epithelial cells 5-10. Most are Dederlein sticks. Gram-positive cocci in small numbers. Slime in a small amount.	Normal condition. It occurs in most healthy women.
III	Medium 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 sticks of Dederlein. There are "key" cells. Slime - a moderate amount.	Inflammation of the vagina - colpitis. Symptoms may occur: creamy vaginal discharge, itching, burning, discomfort during intercourse. In some women, this condition is asymptomatic.
IV	Medium 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 sticks may be missing. Mucus in large quantities.	Pronounced inflammatory process. Symptoms: profuse vaginal discharge (white, yellowish, greenish), often with an unpleasant odor. Itching, burning, dryness, discomfort. Discomfort, pain during intercourse.

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

In smear microscopy for flora, the norm is:

• flat cells of the vaginal epithelium - up to 10 in the field of view;
• single leukocytes - up to 10 in the field of view;
• cells of the intermediate layer - 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.

The smear should not contain:

• 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 .

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

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

Leukocytes are white blood cells that are designed to fight infection. They can go through the wall of blood vessels and move independently. Leukocytes have the ability to phagocytosis - they absorb bacteria and digest them. After the bacterium is digested, the leukocyte is destroyed. At the same time, substances are released that cause inflammation, manifested by swelling and redness of the mucosa.
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 antibiotic susceptibility done in a smear test?

Sensitivity to antibiotics or antibiogram- Determining the sensitivity of bacteria to antibiotics. The study is carried out simultaneously with sowing a smear if pathogenic bacteria that cause inflammation or genital infections are found in the vagina.

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.

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

How is antibiotic susceptibility testing done?

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) 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?

Smear culture or bacteriological culture (bakposev) smear- This is a laboratory study in which the contents of the vagina are placed in a nutrient medium and create optimal conditions for the growth of bacteria.

Research objectives:

• 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.

In what case is a smear culture prescribed?

• 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”.

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

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

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

Vaginal microflora (vaginal flora) are microorganisms that inhabit the vagina. They are part of the general human flora. The number and type determines the woman's health status. Normally, in a smear for microflora, bacteria of the genus Lactobacilli (lactobacilli), which protect against pathogenic microorganisms, should prevail.

Lactobacilli produce lactic acid, which is supposed to prevent the development of pathogenic bacteria (Staphylococcus aureus, Escherichia coli, etc.), but a small amount in their test results is acceptable. They also produce hydrogen peroxide (H 2 O 2 ), which has a broad antimicrobial spectrum of action, and various bacteriocins, which also kill other bacteria, but have a more narrowly targeted effect.

The normal vaginal microflora may differ in some ethical groups. Several studies have shown that a significant proportion (7-33%) of healthy women (especially black and Hispanic women) lack significant amounts of lactobacilli. Their role is played by lactic acid bacteria from other genera, which are also capable of releasing lactic acid. Therefore, it is assumed that when establishing the norm in a smear in women, the emphasis should be on the pH of the vaginal environment, and not just on the presence of lactic acid.

During the examination of a woman, a gynecologist takes a biological sample from the genitals in order to study the microflora and determine the degree of purity. The fence is carried out from the walls of the vagina, cervical canal and urethra. A diagnostic procedure is necessary to determine the composition of the microflora in order to exclude the inflammatory process.

Biological material is taken during a routine examination, as well as for complaints, such as pain above the pubis, itching and burning of the genital organs, as well as discharge indicating an inflammatory process.

Microflora smear: what every woman needs to know?

The procedure for taking a biological sample is painless. The doctor inserts a speculum with a central lock, allowing you to expand the vagina to examine the surface of the cervix. Material from the wall of the genital organs is taken with a special brush or cotton swab.

Before going to the "women's doctor" it is necessary to follow certain rules that increase the reliability and information content of the analysis:

• for 2-3 days do not enter into intimate relationships;
• douching is prohibited;
• taking a bath on the eve of a visit to the doctor is not recommended;
• when carrying out hygienic intimate procedures, use a special non-drying soap;
• during menstruation, a visit to a gynecologist is not recommended; it is best to take this analysis immediately after it stops;
• do not empty the bladder for at least 2-3 hours.

If a woman is taking any medications, she should tell her doctor about it. Carrying out therapy with certain drugs (for example, antibiotics) can distort the result of the study.

The norm of the vaginal microflora

In a healthy woman, about 95% of lactobacilli are determined in a smear. The lactic acid synthesized by these microorganisms maintains the necessary environment of the vagina, thereby providing protection against the predominance of pathogenic flora.

With a decrease in immunity (for example, during pregnancy, hormonal failure, after stress), the number of lactobacilli decreases. This entails a weakening of the female body, which is fraught with increased predisposition to infectious diseases of the genital area.

Normally, in addition to lactobacilli, the presence of gardnerella and candida in small quantities is allowed in the smear. With a decrease in immunity, pathogenic microorganisms begin to multiply rapidly, suppressing "milk" bacteria. This leads to a violation of acidity, which is fraught with the development of vaginal dysbacteriosis, as well as gardenelosis and candidiasis.

Analysis indicators - how to decipher them?

The form with the result of the analysis is issued to the doctor or directly to the woman herself. To your attention general information that helps to understand the laboratory study.

Tabular information should not be used for self-treatment! Incorrect therapy can aggravate the inflammatory process and lead to an unfavorable outcome!

Table. The place where the smear was taken.

To your attention is another table - a transcript of the result of the study (norm and deviation).

Indicator (abbreviated)	Indicator (full)	V (norm)	C (norm)	U (norm)	What can the excess of the indicator indicate
Le	Leukocytes	0-10	0-30	0-6	Inflammation
Ep (pl.ep)	Epithelium	4-10	4-10	4-10	Inflammation
Slime	Slime	Moderate quantity	Moderate quantity	Not	sign of infection
Gn	Gonococci	—	—	—	infectious disease gonorrhea
Trich	Trichomonas	—	—	—	Infectious disease - trichomoniasis
Chlam. tr	Chlamydia	—	—	—	Infectious disease - chlamydia
Key. cells	key cells	—	—	—	Inflammation (bacterial vaginosis)
Cand	Candida	—	—	—	Infectious disease - candidiasis
Gr.(+)	Gram-positive rods	+	+	+	If not detected, then a violation of the microflora is possible
Gr.(-)	Gram negative rods	—	—	—	The appearance is regarded as dysbacteriosis or possible inflammation

The degree of purity of the gynecological smear

In medicine, the general state of the vaginal microflora has a certain formulation. There are four degrees of purity of a gynecological smear, which can be used to determine the presence of inflammation.

First degree of purity. Leukocytes - from 0 to 4-5, vaginal pH - acidic. The flora is abundantly populated by lactobacilli. Epithelium and mucus in moderation. The initial degree of purity occurs in girls who do not live sexually and in healthy women in the absence of inflammatory diseases (including chronic ones) of the genital organs.

The second degree of purity. Leukocytes - from 5 to 10, pH of the vagina - acidic. In the microbiological flora, there is a coccal infection or yeast fungi (the percentage of normal and pathological microorganisms is approximately the same, or in other words - mixed flora). Flat epithelium and mucus in moderation. The second degree of purity is not ideal, however, there is no need to apply treatment. A woman becomes vulnerable, so she should increase local immunity to prevent the development of inflammation.

Third degree of purity causes anxiety and concern, since the smear contains an increased number of epithelial cells and pathogenic microflora with the almost complete absence of lactobacilli. The pH of the vagina is slightly acidic or alkaline.

The third degree of purity of the vagina is considered a bad result, signaling the current inflammatory process. It is important for a woman to undergo serious therapy in order to recover as soon as possible and avoid complications.

The fourth degree of purity. Doderlein sticks (or lactobacilli) are not found even in single quantities, so the pH reaction will definitely be alkaline. The flora consists entirely of pathogenic microorganisms, it is impossible to count leukocytes, since they are visualized throughout the field. This is an extreme degree, signaling danger. A woman needs, in addition to treatment, to undergo a comprehensive examination in order to exclude dangerous diseases of the genital organs (for example, the current oncology of the genital organs often “gives out” a bad test result).

Table. Laboratory assessment of the purity of the smear.

Name of the required indicator	1 degree	2 degree	3 degree	4 degree
lactobacilli	+++	++	+	—
comma variabile bacteria	—	—	++	++
Gr (-) coccal flora and rods	—	—	++	++
Streptococcus, Trichomonas, Gonococcus, Chlamydia	—	—	-/+	+++
Assessment of the number of leukocytes	—	+	++	+++
epithelial cells	In a single quantity	+	+	++
Candida	—	-/+	++	+++

A smear test for microflora is an important and quick diagnosis that allows you to identify a serious pathology in the early stages. Timely and correct treatment will allow you to get rid of the disease, preventing its transition to the chronic stage. Young girls and women planning to become a mother should pay great attention to reproductive health so that in the future they will not face the problem of conceiving or successfully carrying a pregnancy.

Depositphotos/lanakhvorostova

A smear on the flora is an integral procedure that is performed by a woman who has visited a gynecologist. This simple and accessible analysis allows you to detect many pathological conditions that, at times, do not manifest themselves clinically. Such diseases include thrush, bacterial vaginosis, colpitis, STIs and others.

Indications

A smear on the flora in women is performed in the following cases:

• Unpleasant sensation in the vestibule of the vagina: itching or burning;
• Pain or cramps in the lower abdomen;
• As a preventive measure;
• When planning a pregnancy;
• Against the background of long-term antibiotic therapy.

Training

You can take a smear for microflora regardless of the day of the menstrual cycle. The exception is the days of immediate menstruation. The fact is that monthly bleeding affects the effectiveness of the analysis and can lead to false positive or false negative results. The best days for taking a smear are the days preceding the onset of a new menstrual cycle or immediately after the critical days.

• douching;
• Suppositories;
• Kremov;
• Tablets;
• Lubricants.

Direct preparation for the manipulation of taking a smear on the microflora of the fair sex consists in the hygienic treatment of the external genital organs, which is performed on the previous day in the evening. Intimate hygiene involves washing with warm running water without soap.

Analysis of the results

Upon receipt of the smear results, the following inclusions can be found in it:

• Leukocytes;
• The epithelium is flat;
• Slime;
• lactobacilli;
• Yeasts and yeast-like fungi;
• "key cells";
• Trichomonas;
• gonococci;
• coli;
• Strepto-, staphylo-, enetorococci.

Some of them are the norm and constitute a biocenosis in the vagina of an absolutely healthy woman. The presence of some bacteria, as well as an increased content of opportunistic bacteria, indicates the presence of a particular pathological process.
The correct interpretation of the smear on the microflora in women is very important at the stage of preliminary diagnosis of the disease.

So, a microflora smear can have the following letter designations and abbreviations:

• "V" is short for vagina, or vagina. Everything that is indicated opposite this column refers to the flora that is in the vagina.
• "C" is short for cervix, or cervix. Accordingly, it reflects the result of microflora in the cervical canal.
• "U" is the letter designation for the uretra, or urethra. The values ​​next to this letter will be understood by the doctor as indicators of the flora in the urethra.
• "L" - a smear on the flora reflects the number of leukocytes.
• Ep is squamous epithelium.
• "abs" is a Latin designation that should be interpreted as the absence of something. "gn" is the designation for gonococci, the microorganisms that cause gonorrhea.
• "trich" is an abbreviation for another pathological bacterium, Trichomonas, which causes trichomoniasis.

A smear on the flora in women is the norm of a table that clearly demonstrates the results of the analysis:

Indicator		Norm
	V	U	C
Leukocytes (L)	0-10	0-5	0-30
Epithelium squamous (ep.)	Up to 5-10 in sight	Up to 5-10 in sight	Up to 5-10 in sight
Slime	moderately	Moderate/absent	moderately
Yeast, yeast-like fungi, fungi of the genus Candida	missing	missing	missing
Gonococci	missing	missing	missing
key cells	missing	missing	missing
Trichomonas	missing	missing	missing
thlamydia	missing	missing	missing

Deviations of indicators of a vaginal smear from the norm

The deviation of the results from the norm depending on the indicator should be interpreted as follows:

1. With an increase in the number of leukocytes, the presence of an inflammatory process should be suspected. Normally, the state of leukocytosis can be observed only in pregnant women. Their indicator can rise to 20-30 in the field of view.
2. The squamous epithelium in a smear in women may deviate from normal values ​​both upward and downward. Its complete absence indicates atrophic processes in the uterus, which usually occurs with a lack of the hormone estrogen. An increased amount, in turn, testifies in favor of inflammation in a woman's body.
3. Mucus is normally produced only in the vagina and the cervix. Excessive mucus secretion is another sign of inflammation.
4. Lactobacillus in a female smear and other gram-positive rods, when reduced, increase the risk of inflammation due to a low immune response.
5. The presence of pathogenic microorganisms (trichomonads, gonococci and chlamydia) are an indicator of the presence of diseases such as trichomoniasis, gonorrhea and chlamydia, respectively.
6. The appearance of key cells is characteristic of a pathology such as bacterial vaginosis.
7. A smear on the flora in women containing yeast, fungi of the genus Candida indicates the presence of thrush in her.
8. An increased content of opportunistic cocci in a smear is an indicator of infection in the female genital organs.
9. The appearance of Escherichia coli (E.Coli) in a smear means that the flora of the end section of the intestine (rectum) has entered the vagina. This could happen with improper hygiene, wearing thongs. E. coli found in a smear in women accompany the development of bacterial vaginosis.

Degrees of purity of the vagina

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.
• 3rd 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.

Thus, a flora smear is an important analysis to help a gynecologist make a preliminary diagnosis and identify an inflammatory process in the gynecological area in a woman. After this analysis, additional ones may be required, such as planting flora and determining sensitivity to antibacterial drugs, which together will help the doctor prescribe adequate treatment.

Regular visits to the gynecologist for preventive purposes allows you to maintain women's health in the norm and timely detect pathologies. Gynecological smears for flora and purity are an accessible and informative diagnostic method that is extremely important for determining infectious and inflammatory pathologies of the female genital area.

More about the degrees of purity of the vagina

A swab for the degree of purity of the vagina is performed by a gynecologist at an appointment or is taken in a private laboratory. In a healthy state, the microflora includes beneficial microorganisms - Doderlein sticks, or lactobacilli. They are necessary to protect against the penetration and reproduction of pathogens by stimulating the function of macrophages, as well as to ensure optimal fertilization: thanks to their functioning, weakened spermatozoa cannot get through the genital tract to the egg.

However, opportunistic and pathogenic microorganisms can also be found in the vagina, and the flora can be both aerobic and anaerobic (but anaerobes normally predominate). Pathogens can provoke inflammatory diseases under certain conditions. Characteristics of the balance of the vaginal microflora can be expressed in degrees of purity. The table below details each degree.

Degree of purity	Characteristic
First	Doderlein sticks in a normal amount, a moderate amount of epithelial cells, leukocytes in an acceptable amount (up to 10 per field of view).
Second	Doderlein sticks are less than the normal amount, coccal flora is added in a small amount, leukocytes and squamous epithelium in a smear for flora in an acceptable amount.
Third	Leukocytes and epithelial cells in excess of the norm, few lactobacilli, a large number of cocci. There are more opportunistic microorganisms in the smear than Doderlein sticks.
Fourth	A large number of leukocytes (more than 30 per field of view) and epithelium, lactobacilli are absent, the presence of pathogenic microorganisms. At the fourth degree of purity, there may be a lack of flora in the smear - namely, normal, lactobacillary.

The first and second degrees of purity are considered variants of the norm. The third and fourth talk about active pathological processes that require the immediate start of treatment. The second degree of purity of the vagina is most common.

What is found in the smear

In order to correctly understand the results of the smear analysis for the degree of purity, you need to figure out what elements can be found in it:

1. Leukocytes. Normally, the vagina should contain up to 10 leukocytes per field of view. These cells are needed to protect against pathogens. An increase in the number of these cells indicates an active inflammatory process.
2. Squamous epithelial cells in a smear. In a healthy state, a smear should contain from 5 to 10 epithelial cells. An increase in the content of epithelial cells indicates an inflammatory process, and a decrease is possible with hormonal imbalance. In addition, the number of epithelial cells in a smear may vary depending on the phase of the menstrual cycle.
3. Atypical epithelial cells. Their presence makes it possible to suspect an oncological process.
4. Mucus in a smear on the flora should be in moderation. An increased mass of mucus indicates either inflammation, or non-compliance with the rules of personal hygiene and preparation for the study.
5. Erythrocytes. Single erythrocytes can be found in a smear depending on the phase of the cycle. If their number is more than normal, then this indicates inflammation, erosion, or injury to the mucous lining of the vagina.
6. Rod flora. A large number of Doderlein sticks, or lactobacilli, is a necessary condition for the health of the female reproductive system.
7. . Microorganisms having a spherical shape. They can be opportunistic (staphylococci, streptococci) and pathogenic (gonococcus is a pathogen that causes gonorrhea).
8. Fungi of the genus Candida. Conditional pathogen, under certain conditions (deterioration of the functioning of the immune system) provoking candidiasis. Often, candidiasis occurs with intensive antibiotic therapy.
9. Gardnerella are small sticks. Conditional pathogen, the increase in the number of which causes bacterial vaginosis.
10. The key cells in the flora smear are epithelial cells “glued together” either by gardnerella or other microorganisms. Their appearance most often indicates bacterial vaginosis.
11. Trichomonas. Pathogenic microorganisms that provoke specific inflammation - trichomoniasis.

Vaginal microflora (vaginal flora) are microorganisms that inhabit the vagina. They are part of the general human flora. The number and type determines the woman's health status. Normally, in a smear for microflora, bacteria of the genus Lactobacilli (lactobacilli), which protect against pathogenic microorganisms, should prevail.
Lactobacilli produce lactic acid, which is supposed to prevent the development of pathogenic bacteria (Staphylococcus aureus, Escherichia coli, etc.), but a small amount in their test results is acceptable. They also produce hydrogen peroxide (H 2 O 2 ), which has a broad antimicrobial spectrum of action, and various bacteriocins, which also kill other bacteria, but have a more narrowly targeted effect.

The normal vaginal microflora may differ in some ethical groups. Several studies have shown that a significant proportion (7-33%) of healthy women (especially black and Hispanic women) lack significant amounts of lactobacilli. Their role is played by lactic acid bacteria from other genera, which are also capable of releasing lactic acid. Therefore, it is assumed that when establishing the norm in a smear in women, the emphasis should be on the pH of the vaginal environment, and not just on the presence of lactic acid.

During the examination of a woman, a gynecologist takes a biological sample from the genitals in order to study the microflora and determine the degree of purity. The fence is carried out from the walls of the vagina, cervical canal and urethra. A diagnostic procedure is necessary to determine the composition of the microflora in order to exclude the inflammatory process.

Biological material is taken during a routine examination, as well as for complaints, such as pain above the pubis, itching and burning of the genital organs, as well as discharge indicating an inflammatory process.

When should a woman take a smear for flora?

A woman is recommended to take a smear on the flora at each visit to the gynecologist, in addition to the general diagnostic and preventive purpose, it is possible to use this method to identify those diseases that are diagnosed much earlier than symptoms appear.

Indications for the delivery of a smear are:

• Discharge from the genital tract, which may not always be pathological in nature, but simply be plentiful or accompanied by an unpleasant odor.
• Itching in the vagina or perineum, as well as pain or discomfort.
• Maceration of the skin.
• The sampling of material is necessary for preventive purposes annually.
• Before the start of antibacterial therapy from the female genital organs, as well as after treatment in order to control the assessment.
• In order to control the state of the microflora before surgical interventions, both in the area of ​​​​the external genital organs and internal ones.
• This is necessary to prevent infection and the development of complications.
• Microflora control during pregnancy. In this case, the control is carried out three times in the first weeks of pregnancy, before going on maternity leave, as well as at 36 weeks.
• This smear is screening when visiting a gynecologist, should be taken after each examination.

Each specialist performing the reception can take the material.

How to prepare?

In order to obtain reliable results of the analysis, it is required:

• During the day before the manipulation, do not douche, both with medicinal and herbal remedies, and with ordinary water.
• Avoid sexual contact especially without protection. In this case, fragments of seminal fluid may be found, which makes it difficult to make a diagnosis.
• Do not use any medication during the week, especially from the antibacterial and antifungal groups. This applies to both local and systemic forms.
• Any vaginal forms of funds are cancelled. It is forbidden to cancel only vital drugs.
• Do not take material during menstruation, since a large number of erythrocytes enter the obtained material, which violates the clinical picture of the process.
• Do not conduct an ultrasound examination using a vaginal probe no earlier than one day before taking a smear. This explains the ingress of a polymer gel into the biological material, which replaces the cellular composition of the smear.

How is a smear taken?

The optimal time for sampling is the middle of the menstrual cycle:

• Normally, a smear for microflora in a woman is taken from several sites at once. First of all, this is the posterior vault, the place where the maximum accumulation of microbes occurs. The urethra is the area where the fence is made in order to clarify the presence of pathogens that are tropic for this area.
• The next site is the cervical canal, this is the anatomical region that is the most vulnerable and dangerous in terms of the development of the inflammatory process.
• The material is taken with a special spatula or a Volkmann spoon.
• Do not damage the walls of the mucous membrane and, the movements should be soft, slightly scraping.
• After obtaining the required amount of content, it is applied to a glass slide, evenly distributing over the surface, so that no thickening areas are created.
• The slides are then dried at room temperature. and sent to the laboratory for further diagnosis.
• Already in it, special reagents are applied for further detection of microorganisms and examination under a microscope.

Analysis cost

A smear for flora is made in any budgetary institution absolutely free of charge, since this method is one of the screening and mandatory ones. In addition, this is the minimum examination of a woman for preventive purposes.

In private clinics, the cost of such an analysis can be about 200-300 rubles. Not always a smear will be free only in the antenatal clinic, it can be done free of charge.

How to quickly recover from an infection?

Restoration and preservation of a sufficient amount of useful intestinal normal flora - lacto- and bifidobacteria, helps protect the intestinal mucosa from the penetration of pathogenic bacteria and their toxins into the blood and lymph, eliminate toxins, create an environment in which pathogenic microorganisms cannot continue their vital activity and are excreted from the human body . It is important that the waste products of beneficial bacteria help the immune system to remain active in the fight against harmful bacteria.

Synbiotic biocomplex Normoflorina - containing live active lacto- and bifidobacteria and their metabolites with anti-inflammatory, antiseptic, immunogenic and nourishing action on mucous membranes has established itself for many years as an active helper and fighter against pathogenic bacteria for babies and adults, pregnant women and patients with various diseases . Quite quickly, when using Normoflorins, intoxication is removed and intestinal function and general well-being are restored.

Recommended: start taking Normoflorins as early as possible in age dosages - L - 10-15 minutes before meals in the morning (+ lunch for constipation), D - lunch or evening 20 minutes before meals, B - at night or in microclysters. The duration of admission is 3-4 weeks, until the bowel function is fully restored and overall well-being improves. It is advisable to take sorbents on an empty stomach for 10-14 days - to remove toxins - zosterol or pecto, they reduce putrefactive, fermentation processes, increased gas formation, improve bowel function.

It is important to consolidate the effect of restoring microflora, improve the functioning of the pancreas, liver, intestines, immunity - for this it is good to use functional nutrition - Harmony of Life - for a month. It also contains live useful lacto- and bifidobacteria, their metabolites and pectin. Delicious, healthy and effective!

What is the difference between a smear for flora and bakposevom?

Many women are interested in the question about the differences between bacterial culture and a smear on the flora, whether they are the same analysis, and whether there is a difference between them.
Smear on flora - This is the examination of the contents under a microscope. To do this, the material is taken, after which it is fixed with special dyes and substances, such as ethyl alcohol. Microorganisms turn out to be dead in this way, and only those that fall into the field of view are counted. In this case, you can see only leukocytes, erythrocytes, the qualitative composition of the microflora, as well as the presence of specific pathogens.

Bacterial culture - This is a type of laboratory study in which the growth of microorganisms is determined, as well as the clarification of sensitivity to antibacterial agents. To do this, the material obtained from a woman is placed on a special nutrient medium, not allowing it to dry out, as well as with the presence of nutrient material for the possible nutrition of bacteria.

The method is not common, as it is considered quite expensive. At the same time, its efficiency is quite high, this is due to the fact that in some cases a small amount of bacteria may not be noticed, and with their growth, the formed colonies are easily determined.

In addition, it helps to choose the most appropriate treatment. This is especially important in the presence of a recurrent process, as well as the definition of a specific pathogen.

Why is antibiotic susceptibility done in a smear test?

Sensitivity to antibiotics or antibiogram– determination of the sensitivity of bacteria to antibiotics. The study is carried out simultaneously with sowing a smear if pathogenic bacteria that cause inflammation or genital infections are found in the vagina.

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.

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

How is antibiotic susceptibility testing done?

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) 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.

The degree of purity of the vagina

According to the results of a smear on the flora, its condition is assessed. The main indicators in this case are Dalerlein sticks, leukocytes, epithelial cells, as well as other representatives.

Conventionally, the state of the environment is usually divided into 4 degrees:

• 1 degree means the complete health of a woman from the microflora. It is represented only by obligate microorganisms, such as Daderlein sticks and lactobacilli. It is they who contribute to the acidification of the environment, which prevents the reproduction of other flora. In this case, leukocytes, microbes, as well as erythrocytes and pathogenic microorganisms will not be observed.
• At 2nd degree, the most frequent group in women who are sexually active, the presence of not only obligate microorganisms, such as lactobacilli, but also single cocci is noted. It is not excluded that leukocytes may also appear, in an amount of not more than 10 pieces. Epithelial cells should not exceed 5. This cannot be considered a pathology, since lactobacilli cope with their function, there is no inflammatory process, but this flora can come from contact with a sexual partner. Cocci are normally found on the head of the penis.
• At 3 degrees already observed inflammatory process in the vaginal environment. This is due to the fact that there is a change in the environment, it becomes alkaline, not acidic. Lactobacilli decrease in number, while microorganisms such as streptococci, staphylococci, fungi and E. coli, on the contrary, increase. The inflammatory process is also confirmed by increased leukocytes, there are more than 30 of them in the field of view. In this case, a woman may complain about the appearance of pathological symptoms, such as itching, burning and discharge from the genital tract.
• At 4 degrees the inflammatory process is already pronounced, there is a manifestation of dysbacteriosis, which is also called bacterial vaginosis. In this case, the medium will always be alkaline, shifted almost as much as possible in this direction. Lactobacilli are absent, and the flora is represented by a pathogenic group of microorganisms. Often you can see representatives of sexually transmitted infections, although there may be non-specific ones. The number of leukocytes increases significantly, can reach 50 or more. At grade 4, mandatory treatment is required even without the absence of symptoms on the part of the woman.

Why is the level of white cells elevated?

The reasons for the detection of an abnormal indicator of white blood cells are most often inflammatory processes:

• cervicitis (the process occurs inside the cervical canal);
• salpingoophoritis (ovaries and tubes);
• endometritis (the uterine mucosa suffers);
• vaginitis (intravaginal pathology);
• urethritis (inflammation affects the urinary tract).

Sexually transmitted infections also cause an increase in white blood cells. These include:

• genital herpes;
• cytomegalovirus;
• trichomonas;
• pale treponema;
• tubercle bacillus (Koch);
• mycoplasma, ureaplasma;
• gonococcus;
• chlamydia;
• fungi of the genus Candida, actinomycetes.

Exceeding the norm is detected during oncological processes in the organs of the reproductive system, dysbacteriosis of the vagina, intestines. And also high leukocytes in a smear appear with an exacerbation of the allergic process, endocrine pathologies, weakening of local and general immune defenses, stress, physical overwork. Violation is detected in women after a miscarriage.

Interpretation of smear results

coccal flora

1. The coccal flora is a large group of microorganisms, which is an opportunistic flora for the human body. At the same time, it includes a variety of microorganisms, even on the mucous membrane. It has a specific shape for them, these are spherical or coffee bean-like bacteria, which are also called cocci.
2. In addition, this group may include absolute pathogens, such as gonococci. They should not be in the vagina of a healthy woman at all, and the detection indicates a sexually transmitted infection and is characterized by severe symptoms. They pose a great danger due to the development of complications.
3. Not always the detection of cocci in a smear on the flora indicates an inflammatory process, while it is worth considering that minor changes in the state of immunity, as well as violations of hygiene and nutrition, lead to their rapid growth. They can be introduced from a sexual partner if sex is carried out without the use of protective equipment.

In a smear for flora from the cervical canal, coccal flora should not be detected at all.

The coccal flora on the vaginal mucosa is represented by both gram negative and gram positive microorganisms.

This is due to the fact that some bacteria are able to stain with a special dye that has a dark blue or purple color. Gram-positive microorganism in this case has a dark blue color, but negative ones have a lighter pink color.

Scientists have found that those bacteria that do not have the ability to stain are more resistant to the action of antibacterial agents. This will be due to the fact that they have a thick wall, so the dye, like the drug, is more difficult to penetrate into the cell cavity.

The most common gram positive include staphylococci and streptococci, which do not always give an inflammatory process in the vagina. And in a smear on the flora are contained in a single amount.

Gram-negative flora is more likely to cause vaginal disease. The most famous coccus is considered gonococcus.

Dederlein sticks

1. Dederlein's sticks are a bacterium that will be the basis for the microbiocenosis of the vagina. It belongs to lactobacilli, which have an anaerobic type of life activity. They are representatives of the obligate flora, this is due to their symbiotic variant of existence. In a small amount they can be found on the intestinal mucosa.
2. Their main function is the production of lactic acid, which helps maintain an acidic environment. It is this pH level that will be optimal to prevent the development of pathogenic microorganisms.
3. These bacteria are quite large compared to other representatives. In addition, they are unable to move. The vagina is represented by several species of the genus Lactobacilli. In the environment, they are extremely unstable, so they die quickly enough.
4. In addition, they cannot form a spore for subsequent protection in the environment. Sensitive to the action of chemical and physical factors. Life activity is also affected by the state of the body's immunity and metabolism. For its normal functioning, regular and good nutrition is required, as well as compliance with the rules of hygiene.

Leptothrix

1. Leptothrix- This is a bacterium that belongs to the representatives of conditionally pathogenic flora.
2. In the human body, they show vital activity on the mucous membrane of the oral cavity or vagina. They are Gram-negative.
3. They normally live and reproduce in an anaerobic environment. They live under anaerobic conditions.
4. They have the form of a long hair or a thin thread that has a thickened end. Externally form clusters that form loop-like fragments
5. Not capable of budding. Under environmental conditions, they divide and multiply, most often they can be found in a fresh water reservoir or pool, sometimes they are found in ponds.
6. In the normal state of immunity, the development of the inflammatory process does not occur. But during the action of a provocative environmental factor, as well as a decrease in the body's defenses. Most often, the transmission method will be insufficiently pure water, the sexual route is also possible, but much less common.

In the absence of symptoms of pathology, the presence of leptothrix does not require additional treatment, but in the event of the development of the appearance of even a minor clinic, drug therapy is prescribed. The frequency of occurrence of this bacterium increases in the presence of HIV infection.

Urogenital infections caused by enterobacteria

Urogenital infections caused by enterobacteria - diseases, symptoms and causes

Diseases caused by gram-negative rods belonging to the Enterobacteriaceae family. Urogenital infections are caused by representatives of the genera Escherichia, Klebsiella, Enterobacter, Serratia, Hafnia, Salmonella, Edwardsiella, Citrobacter, Providencia, Proteus. Enterobacteria can be expelled from the vagina with vaginitis, cervicitis, or other inflammatory process. Very often they are found in combination with anaerobic microorganisms and Trichomonas. The presence of enterobacteria in the vagina is typical for women who do not follow the rules of personal hygiene.

E. coli (Escherichia coli) is one of the representatives of the normal intestinal flora, a saprophyte of the large intestine. Conditionally pathogenic and pathogenic serotypes of Escherichia coli cause the appearance of various pathogenetic and clinical forms of the infectious process. Their pathogenic features to a certain extent correlate with the presence of the corresponding antigen, i.e., with belonging to one or another serogroup. With urinary tract infections, serogroups 02, 06, 09 and others are found, with cholecystitis - 01, 08, 011, etc.

Coli-infection of the urinary tract is more common in girls and women, especially in the presence of vulvitis and vulvovaginitis.

The source of the disease is patients with coli infection or bacteria carriers of pathogenic serotypes of Escherichia coli. The mechanism of infection is fecal-oral, sometimes sexual. A hematogenous route of penetration of the pathogen into the kidneys and urinary tract from any extrarenal focus of infection is possible.

In adults, coli infection is most often manifested by inflammatory changes in organs located near the intestines - the urethra, bladder, vagina, uterus (urethritis, cystitis, pyelitis, pyelonephritis, colpitis, endometritis) or communicating with the intestines - the gallbladder, bile ducts ( cholecystitis, cholangitis). In children, coli infection can be localized in the lungs. Generalization of infection and development of sepsis are possible.

It is not uncommon for E. coli in association with staphylococcus or some gram-negative bacteria (Proteus, Pseudomonas) to cause nosocomial infections, in particular in gynecological clinics, in neonatal wards.

The final diagnosis of a disease caused by Escherichia coli can be established only on the basis of a bacteriological study, including the isolation of a pure culture of E. coli, its identification by morphological and biochemical characteristics, and the determination of a serogroup.

Antibiotics (polymyxin, ampicillin, tetracyclines, etc.) are used to treat coli infections.

Klebsiella pneumoniae, formerly known as pathogens of the respiratory system, is now often the cause of intrauterine infections that occur with damage to the respiratory and urinary tract. When grown on nutrient media, these bacteria form characteristic mucoid colonies; microscopy defines wide polysaccharide capsules around immobile cells.

Enterobacter aerogenes is found in urinary tract infections and in sepsis. Often they are motile, form slightly slimy colonies, and some strains form a capsule.

Serratia marcescens are small rods that can form an intense red pigment in cultures (a variable trait).

Representatives of the genus Serratia usually ferment lactose very slowly, some strains ferment urea (weakly). Unpigmented variants of these bacteria cause toxic sepsis.

Hafnia alvei is sometimes isolated, in addition to gastroenterocolitis, also in urethritis or vaginitis.

Bacteria from the genera Edwardsiella, Citrobacter are similar in biochemical properties; their pathogenicity has been problematic until recently. Certain serotypes are found in sporadic or mass food poisoning, urinary tract infections, etc.

Representatives of the genus Salmonella cause gastroenteritis, sepsis, endometritis, and urinary tract infections.

Providencia are biochemically similar to proteins, deaminate amino acids (for example, lysine), do not hydrolyze urea; they are detected in urinary tract infections, sepsis and other diseases.

transmission paths. Most of the bacteria of this family make up a significant part of the normal aerobic intestinal flora and usually do not cause disease, but, on the contrary, are involved in ensuring its normal functioning. These microorganisms become pathogenic only when they penetrate into the tissues of the body, especially in the urinary and biliary tract, lungs, peritoneum or meninges, where they can cause an inflammatory process. They can penetrate into the bloodstream (when using venous or urethral catheters); get into the genitourinary tract during instrumental studies (nosocomial transmission); cause infectious lesions of the urinary tract after the introduction of contaminated drugs, especially after their intravenous use. Possible sexual transmission.

Epidemiology and general pathology. E. coli and some other bacteria of the Enterobacteriaceae family settle in the intestines of a child within a few days after his birth and from that moment make up the main part of the normal aerobic microflora of the body. When inflammation occurs, regardless of the clinical picture of the disease and etiopathogenesis, a large number of different types of microorganisms often simultaneously enter the urinary tract. Within a short time, one of them begins to dominate, inhibiting the growth of others.

The dominant species causes about 80% of all bacteria. When the immune mechanisms of the body do not respond to any microorganism, the latter quickly takes root in the urinary system. For example, individuals with blood group III (B) do not produce antibodies against E. coli serotype 086 due to the identity of the antigens. According to clinical observations, such individuals are more susceptible to coli infections than people with other blood types.

Urinary tract infections may occur after bladder catheterization, bacteremia and urosepsis are possible. Often, bacteremia is diagnosed in the prostate bed after surgery to remove it (adenomectomy) due to cystitis, bladder atony, sometimes as a result of stone formation, narrowing of the urethra, resumption of pyelonephritis in the past, or asymptomatic bacteriuria. The infection can be introduced by an indwelling catheter during surgery or more often immediately after the intervention. Often lasts for months. With prostate adenoma, gram-negative bacteria are usually not isolated from the gland itself. However, infectious complications in the urinary system are caused by these microorganisms.

In some cases, patients with bacteriuria have elevated blood pressure. The reverse phenomenon is also observed: with increased blood pressure, bacteriuria develops, which can turn into pyelonephritis and complicate the course of hypertension. Therefore, when one of these states arises, it is necessary to assume the possibility of the development of another.

Bacteria of the family Enterobacteriaceae often cause secondary infections, including pneumonia, endocarditis, bacteremia, especially in drug users and in clinic patients.

Clinical manifestations. Manifestations of infections caused by bacteria of the family. Enterobacteriaceae depend on the localization of the pathological process. They cannot be differentiated from other bacterial infections on the basis of symptoms and signs of the disease alone, therefore it is very important to determine the causative agent of the genitourinary system infection, including the species and type characteristics, its amount in 1 ml of fresh urine and sensitivity to antibacterial agents. A systematic study of species, typical and other characteristics of microorganisms - pathogens of infections of the genitourinary system is essential for elucidating the pathogenesis of uroinfections and determining methods for their therapy.

Diagnostics. Depending on the localization of the pathological process, genital secretions, urine, blood, cerebrospinal fluid, etc. are used for research. Gram-negative short rods that can form chains are found in stained smears; they are very similar to each other and only the presence of wide capsules is of diagnostic value for the genus Klebsiella. The test material is simultaneously applied to blood agar and media containing special dyes and carbohydrates, which allows you to quickly differentiate fermenting and non-fermenting colonies. Bacteria isolated on these media are further identified using biochemical and serological reactions. Rapid preliminary identification is possible by the ability of microorganisms to ferment lactose.

Treatment and prevention. Pronounced antimicrobial activity against bacteria of the family. Enterobacteriaceae have ampicillin, tetracyclines, aminoglycosides, gyulimyxins, sulfonamides. However, the sensitivity to these drugs in individual strains is different, so it must be determined by laboratory methods. Multidrug resistance is not uncommon.

In treatment, the effect can be achieved with the simultaneous use of aminoglycosides and furagin or ampicillin; trimethoprim with sulfamethoxazole and polymyxin. Other combinations of antibacterial agents are also advisable, the appointment of drugs that potentiate the action of antibiotics, increase the protective mechanisms of the patient's body, facilitate the delivery of antibacterial agents to the lesions and ensure their therapeutic concentration in tissues and blood serum. Prevention and effectiveness of the fight against these infections largely depend on keeping hands clean, strict adherence to the rules of asepsis and antisepsis (sterilization of instruments, disinfection of equipment), caution in prescribing intravenous drugs and personal hygiene of the genitourinary tract. It is very important to remember that many gram-negative bacteria are opportunistic pathogens and cause the development of the disease in a weakened body. In health care settings, these bacteria are often transmitted by personnel and through instruments or parenteral preparations.

Frequent causative agents of urinary tract infections are bacteria of the genus Proteus from the fam. Enterobacteriaceae. These are gram-negative mobile aerobic rods; do not ferment lactose; produce urease, which leads to the rapid breakdown of urea with the formation of ammonia. They tend to "swarm" and quickly spread over the surface of a dense nutrient medium. The addition of phenylethyl alcohol or 0.1% chloral hydrate to the nutrient medium inhibits swarming. Proteas do not grow well in an acidic environment. transmission paths. Proteus, like other members of the family. Enterobacteriaceae cause disease in humans only when they go outside of their normal habitat (the digestive tract). There are also nosocomial transmission, the spread of infection through sexual contact, as well as in case of non-compliance with the rules of personal hygiene.

Epidemiology and general pathology. Proteas are often found in chronic urinary tract infections, as well as in bacteremia, pneumonia, and focal lesions in debilitated patients or those receiving intravenous drugs. The first place among them is occupied by Proteus mirabilis, which is the only indolegative microorganism among the representatives of this genus. Then come Proteus morganii and Proteus rettgeri. Rarely isolated Proteus vulgaris.

We mentioned above the ability of proteins to form urease, which decomposes urea to ammonia, which contributes to the formation of phosphate stones. Ammonia is toxic to the kidneys, causes necrosis of the kidney tissue, microabscesses. Complement inactivation occurs in the urine. For bacteria, there is more opportunity to multiply unhindered in the kidney tissue, i.e., they become more invasive. Infections caused by urease-producing proteins cause more severe intoxication and destruction of the renal tissue.

Clinical manifestations. Bacteria of the genus Proteus are often found in complications of calculous pyelonephritis, congenital malformations, and after surgical operations. In these cases, various bacteria of this family are often isolated. Enterobacteriaceae. Subsequently, proteins are found in the urine, which cause a chronic, complicated course of urinary tract infection.

Treatment and prevention. Diseases caused by proteins must be treated with drugs that are sensitive to these microorganisms. It should be borne in mind that the sensitivity to antibiotics in different strains of Proteus varies greatly. The most active drugs are gentamicin and amikacin. The growth of P. mirabilis is often inhibited by penicillin and ampicillin. The appointment of cephalosporins (cefotaxime, or klaforan) is indicated.

Prevention of proteic infections, as well as other infectious diseases, should be carried out by organizing and conducting a set of measures aimed at identifying the source of infections, the mechanism of transmission and the susceptibility of the patient's body. The spread of infection must be stopped using aseptic and antiseptic methods. This fully applies to nosocomial infection caused by Proteus.

Deciphering indicators

Table for decoding indicators

Fecal analysis

How to detect overgrowth of Enterobacter cloacae? This can be done using stool or urine tests for bacteriological culture. Let's look at these studies in more detail.

The concentration of Enterobacter cloacae in the feces is determined during the analysis for intestinal dysbiosis. This study is prescribed if the patient has the following symptoms:

• prolonged temperature rise to +38 degrees;
• periodic vomiting;
• diarrhea;
• admixture of blood and mucus in the stool.

A small piece of biomaterial is taken for the sample, preferably with an admixture of mucus or blood (if any). Feces must be delivered to the laboratory within 1 hour. Specialists carry out sowing of faeces on nutrient media. After 5 days, the bacteria in the biomaterial begin to multiply. After that, the number of microorganisms in 1 g of feces is counted. Their concentration is measured in CFU (colony forming units).

Smear on flora during pregnancy

It is indicated to take all women who have been diagnosed with pregnancy. This is due to the fact that the course of pregnancy, as well as the development of the fetus, largely depends on the state of local immunity. The minimum is considered to be a double sampling of material.

1. During pregnancy, there is a decrease in immunity associated with hormonal changes, so there is a high probability that a woman will have a pathogenic flora. Violation of the flora in smears indicates a pathological process, which in most cases requires mandatory treatment. This is especially true for the detection of pathogenic flora, which, if retained on the vaginal mucosa during childbirth, can lead to infection of the fetus. Therefore, women take material and, if necessary, when planning natural childbirth, they sanitize the mucosa.
2. Most often in a pregnant woman in smears on the flora, a micelle of a yeast fungus is detected, which sometimes causes severe discomfort.
3. One of the most dangerous complications associated with a violation of the vaginal flora, are isthmic-cervical insufficiency, the penetration of pathogens to the fetal membranes, their inflammation and thinning.

As a result, we can conclude that this smear will be a very important diagnostic minimum for preventing complications, since with timely diagnosis it is possible to prescribe a treatment that can normalize the condition.

Does the score change with age?

The number of leukocytes in smears should not differ greatly by age. In little girls, young women, and older women, normal values ​​may vary only slightly.

The result of the analysis directly depends on the hormonal background. Therefore, often in girls of puberty, an increased content of white blood cells in a smear is found. And also an increase in the number of protective cells above the norm occurs if the genitals of a child or girl become infected with pathogens. This happens when you violate the rules of individual hygiene, use someone else's towel, washcloth, linen.

Leukocytes in a stained smear

An abnormal phenomenon often accompanies a period of decline in reproductive function. A change in the hormonal balance causes dryness of the vaginal mucosa and injury to the walls of the organ due to itching. It also causes an increased amount of leukocytes found in the smear.

After the age of 50, many women's bodies produce more white blood cells than before. The analysis shows an excess of white blood cells by 1-2 units. Norms of leukocytes in the blood and urine in women.

A significant excess of the norm of leukocytes in a smear in an elderly woman signals a problem. Additional examination and treatment is required.

In some women, over a long period, tests may show the number of protective bodies in excess of the norm. At the same time, other tests do not reveal any signs of pathological processes in women. Polymerase chain reaction, enzyme-linked immunosorbent assay of blood show the norm. This condition does not require the appointment of drug therapy. But regular visits to the gynecologist and analysis of the vaginal microflora are required.

How to maintain the microflora of the vagina?

To maintain normal microflora, a woman needs to follow several rules:

• Regularly carry out hygiene measures using specialized products.
• Avoid frequent douching.
• Do not use drugs without a doctor's prescription.
• When having sexual intercourse with a non-permanent sexual partner, use barrier methods of contraception.
• Regularly conduct a gynecological examination and diagnosis for sexually transmitted infections.
• Monitor the state of immunity, as well as metabolism and endocrine pathologies.
• Maintain a diet.

pathogenicity

Under adverse conditions, Enterobacter cloacae microorganisms can cause inflammatory processes in various organs. This usually occurs with a sharp weakening of the body or against the background of other diseases. Bacteria can affect not only the gastrointestinal tract, but also other organs: lungs, kidneys, bladder. This leads to the appearance of the following pathologies:

• intestinal dysbacteriosis;
• acute pyelonephritis;
• cystitis;
• aspiration pneumonia.

Actively multiplying, enterobacters displace beneficial microorganisms. As a result, the microflora in the gastrointestinal tract is disturbed in humans. This leads to a deterioration in well-being, a further decrease in immunity and a high susceptibility to infections.

Bacterial vaginosis

Bacterial vaginosis is an imbalance of the vaginal microflora with single leukocytes and epithelial cells (pH over 4.5).

Bacterial vaginosis is a disease of polymicrobial etiology, which is recorded in 25 - 50% of women attending gynecological clinics.

Studies have found that bacterial vaginosis increases the risk of transmission of HIV and other sexually transmitted diseases.

Risk factors for its development include changing sexual partners, douching, smoking, and unsafe sexual practices.

Recurrent bacterial vaginosis is a serious problem for many women, with a recurrence rate of more than 50% of patients within 12 months of treatment.

Bacterial vaginosis is usually characterized by disturbances in the normal vaginal ecosystem, a decrease in the number of lactobacilli, as well as an increase in the number of various gram-negative and / or anaerobic bacteria.

A significant increase in vaginal anaerobes in bacterial vaginosis is associated with increased production of proteolytic enzymes and subsequent degradation of vaginal peptides to amines.

In an alkaline environment, amines become offensive, cause typical vaginal discharge, and trigger the release of pro-inflammatory cytokines such as IL-1β and IL-8.

Women with bacterial vaginosis usually complain of vaginal discharge with an unpleasant "fishy" odor. However, many women with bacterial vaginosis have no symptoms or complaints.

Release form and composition

The drug has the form of tablets, covered with a soluble film of beige color. Each includes:

• active substance (3 million IU);
• crystalline cellulose;
• povidone;
• crospovidone;
• silicon dioxide, dehydrated;
• magnesium stearate.

Tablets are packaged in contour cells of 5 or 10 pcs. The cardboard box contains 2 blisters. Tablets can also be supplied in glass jars of 10 pcs.

Pharmacological properties of Spiramycin

Pharmacodynamics

The drug belongs to the antibacterial agents of the macrolide group. In small and medium doses, it inhibits the reproduction of pathogenic microorganisms. In high doses, it promotes the death of bacteria. The substance is integrated into the 50S subunit of the bacterial ribosome and blocks the reactions of transpeptidation and translocation.

Unlike other macrolides, the drug is able to combine with several subunit components. A more stable connection with ribosomes provides a long bacteriostatic effect. The drug can accumulate in the bacterial cell in large quantities. The antibiotic is active against:

• staphylococci (including methicillin-sensitive strains of Staphylococcus aureus);
• streptococci;
• meningococci;
• gonococci;
• clostridia;
• diphtheria bacillus;
• chlamydia;
• mycoplasmas;
• treponema pale;
• leptospira;
• campylobacter;
• toxoplasma.

Haemophilus influenzae has variable sensitivity. The antibiotic has no effect on Enterobacteria and Pseudomonas.

Pharmacokinetics

The drug is rapidly absorbed, but only 10-60% of the active substance penetrates into the blood. It is distributed throughout the organs and tissues without getting into the cerebrospinal fluid and the brain.

A small part of the active substance interacts with plasma proteins. In the liver, the antibiotic is converted into active metabolites.

90% of the drug is excreted in the feces. The elimination half-life lasts 8 hours.

Indications for use Spiramycin

The drug is used for:

• acute community-acquired pneumonia (including those caused by mycoplasmas and chlamydia);
• acute inflammation of the mucous membranes of the bronchi;
• exacerbation of chronic bronchitis;
• sinusitis;
• angina;
• inflammation of the middle ear;
• chlamydial arthritis and conjunctiva;
• osteomyelitis and bacterial arthritis;
• bacterial lesions of the prostate;
• infectious urethritis (including chlamydial and gonorrheal);
• sexually transmitted infections;
• purulent lesions of soft tissues (infected allergic and psoriatic rashes, abscesses, phlegmon, erysipelas);
• toxoplasmosis (including in pregnant women);
• prevention of meningococcal lesions of the meninges in patients who have been in contact with the infected;
• prevention of rheumatic damage to the joints and soft tissues;
• elimination of the bacteriocarrier of whooping cough and diphtheria bacillus.

Contraindications

The list of contraindications to the use of Spiramycin includes:

• individual intolerance to the active substance and auxiliary components;
• lack of the enzyme glucose-6-phosphate dehydrogenase (the drug may contribute to the development of hemolytic anemia);
• blockage of the bile ducts.

Method of application and dosage of Spiramycin

For pneumonia and other infectious diseases, take 3 million IU of spiramycin 2-3 times a day. Tablets are drunk after meals. The daily dose should not exceed 9 million IU. The recommended daily dose for the prevention of meningococcal infections is 6 million IU. It is divided into 2 applications. The course lasts 5 days.

Side effects

While taking Spiramycin, the following undesirable consequences may occur:

1. Signs of damage to the gastrointestinal tract. Most often, nausea occurs, which may culminate in bouts of vomiting. Extremely rarely there is ulceration of the mucous membranes of the esophagus, stomach and intestines. Taking high doses of the drug in the treatment of cryptosporidiosis in AIDS patients may contribute to the perforation of the intestinal walls.
2. neurological disorders. Often there are headaches and dizziness. In rare cases, paresthesias, impaired coordination of movements, sleep problems, changes in taste and visual perception appear.
3. Signs of liver damage. Taking Spiramycin may contribute to a transient increase in liver enzymes and the development of non-infectious hepatitis.
4. Violation of the functions of the hematopoietic system. Rarely, acute hemolysis occurs. The drug may contribute to changes in the composition of the blood.
5. Cardiovascular disorders. Taking an antibiotic leads to a prolongation of the QT interval on the cardiogram.
6. Allergic reactions. When using Spiramycin, rashes like urticaria and skin itching occur. In rare cases, swelling of the face and larynx, anaphylactoid reactions develop.

Overdose

An overdose increases the intensity of side effects. When using large doses of the drug, diarrhea and persistent vomiting occur, consciousness is disturbed. No specific antidote has been found. If an overdose is suspected, the patient is hospitalized. In the hospital, symptomatic therapy is administered.

special instructions

Use during pregnancy and lactation

In the presence of strict indications, the drug can be prescribed to pregnant women. The active substance is excreted in breast milk, so breastfeeding is suspended for the duration of treatment.

Application in childhood

Tablets are not prescribed to children under 12 years of age.

Use in the elderly

In the treatment of patients over 65 years of age, dose adjustment may be required.

For impaired renal function

In diseases of the excretory system, a dose reduction of Spiramycin is not required.

For impaired liver function

In liver diseases, constant monitoring of the activity of hepatic transaminases is required.

drug interaction

It is not recommended to use the drug in combination with drugs containing ergot alkaloids. When using an antibiotic in combination with levodopa and carbidopa, the half-life of the latter is extended. Since P450 isoenzymes are not involved in the metabolism of the drug, it does not react with theophylline and cyclosporine. The antibiotic is incompatible with alcohol, so during the period of treatment it is necessary to exclude the use of alcoholic beverages.

Analogues

The following medicines have a similar effect:

• Rovamycin;
• Spiramycin adipate.

Terms and conditions of storage

Tablets are stored in a dark place, avoiding overheating and moisture. Expiration date - 48 months from the date of production.