Analysis of the smear on the flora: how to prepare, what shows?

Among the many laboratory studies, there is a smear on the microflora - an analysis that determines the presence of bacteria at the site of collection, and also identifies them. Flora in the smear can be diverse, depending on where the smear is taken, and on the presence of pathology on this site. Thus, it is possible to diagnose inflammatory processes or diseases that are sexually transmitted.

Taking a smear is quick and without any particular discomfort. To assess the flora in the smear, the seized material is stained, making the microorganisms easier to discern.

What includes a smear on the flora?

Specialists distinguish several diagnostic varieties of the definition of flora in the smear:

1. A general smear provides an assessment of vaginal purity in patients. What does it include:

• indicators of the state of epithelial cells;
• The presence of diseases caused by a microbial or fungal infection.

Bacterioscopy can detect diseases that go through the sexual way.

1. A smear to identify a hidden infection is done to identify diseases that occur without certain symptoms, but can cause a number of long-term complications - for example, infertility. The study of the flora is carried out with the help of PCR-such a diagnostic reaction makes it possible to detect an infectious agent that is not secreted during a general smear.
2. A smear with oncocytology (the so-called Pap test) is performed to exclude oncological processes localized in the cervix. It's not a secret that diagnosing tumors at the initial stages of development often allows successfully curing the disease. In addition, this test helps to determine almost all inflammatory processes, epithelial dysplasia. Doctors advise to undergo such a diagnosis once a year for all female patients.

In addition, a smear is obtained from the urethra (in male patients), from the pharynx and nose, from the ear - depending on what problem they suspect.

Indications for the procedure of the flora in the smear

The definition of flora in the smear is in the list of mandatory tests with routine gynecological examinations. The procedure is conducted by the doctor during the gynecological examination. Taking the material is possible from the vaginal walls, from the uterine neck or from the urethra.

The study helps to find the cause of many health problems - for example, you can find an inflammatory reaction or an infection that passes sexually. Assessment of the state of flora in medical terminology is called bacterioscopy.

In gynecology, a smear is taken in cases where identification of such diseases is required:

• microbial vaginosis;
• inflammatory reaction - vaginitis;
• fungal infection - candidiasis;
• diseases that are transmitted by the sexual mechanism of transmission - gonorrhea, trichomoniasis, etc.

The study is conducted to determine the correct diagnosis if a woman voices such complaints:

• itching, discomfort, burning inside the vagina;
• painful sensations of sexual contact;
• the appearance of unhealthy discharge, often with a characteristic odor;
• pain in the lower segment of the abdomen.

In addition, the swab must be taken at the planning stage and during pregnancy, as well as after antibiotic therapy.

A smear on the flora of men is always taken when visiting a urologist or a venereologist, as well as when passing a medical examination. Especially this kind of research is necessary:

• with atypical discharge from the urethra;
• with male infertility and suspicion of it;
• in diseases that are sexually transmitted, or if they are suspected.

A smear from the nasal cavity and pharynx is relevant:

• in the presence of a raid on the tonsils, with tracheolaringitis, with abscesses in the tonsils, with infectious mononucleosis;
• with suspicion of tuberculosis;
• at a chronic rhinitis, a genyantritis, a pharyngitis;
• with frequent respiratory infections.

Also a smear is taken if diphtheria or pertussis is suspected.

Determination of microflora in the ear is carried out with any variant of purulent otitis, as well as with serous otitis, to identify the causative agent of the disease.

[1], [2], [3]

Preparation

Gynecological definition of flora in the smear is carried out no earlier than three days after the completion of menstrual flow.

A smear on the flora in the menstrual period does not take! The presence of bloody vaginal discharge on the walls of the vagina distorts the results of the analysis, which in most cases may be unreliable.

A smear on the flora on the last day of the month does not give up for the same reason. The optimal period for the study is from the tenth to the twentieth day of the monthly cycle.

To avoid mistakes in the analysis, you need to adhere to other important recommendations:

• for a couple of weeks before the study, complete any treatment with antibiotics and antifungal drugs;
• for a couple of days before the study, refrain from using any intravaginal drugs - douches, tampons, suppositories, irrigation, ointments, etc .;
• for a couple of days, exclude sexual intercourse;
• a day before the diagnosis do not take a bath, and next morning before the study take a shower without the addition of detergents.

Taking a smear from the male urethra also requires some preparation:

• for a couple of days before the diagnostic event, you need to refrain from sexual intercourse;
• morning in the day before the study you need to take a shower;
• a couple of hours before visiting a doctor, it is undesirable to urinate;
• a week before the study must complete the intake of all antibacterial and antifungal medicines.

If you plan to take material from the nasopharynx, then here you need to focus on the preparatory stage, which includes such conditions:

• for a couple of hours before the diagnosis should not take food and liquids;
• on the day of diagnosis, one should not clean teeth and water or rinse throat, use antimicrobial sprays, take antibiotics;
• if you intend to take material from the nose, you should not apply ointment on the mucous membrane, drip solutions or spray sprays before testing.

Taking a smear from the ear is carried out before antibiotic therapy begins.

[4], [5], [6], [7], [8], [9]

Technique of the flora in the smear

• A swab in the flora of women is taken by a doctor in a gynecological office, or in a specially equipped laboratory. Diagnostic manipulation includes such stages:

1. the patient is located in the gynecological chair;
2. the doctor gets access to the vaginal cavity and the uterine neck with sterile mirrors;
3. the doctor removes the material from the back vaginal vault, applies it to a special laboratory glass and sends it to the laboratory;
4. The smear undergoes staining with methylene blue, after which the laboratory assistant determines the variety of bacteria and details the composition of the flora.

In most cases, a gynecological smear is taken simultaneously from three sites: the exit of the urinary canal and the para -urethral tract, the vaginal walls and the cervical canal. If the material is withdrawn from only one of the listed sites, it must be indicated on the form and on the slide: C - from the uterine neck, U - from the urethra, V - from the vagina.

• A smear on the flora during pregnancy is taken at least three times: when a woman becomes registered for pregnancy, as well as at the 30th and 36th week of gestation. If there is a threat of interruption, in case of polyhydramnios, intrauterine infections, the doctor may insist on additional collection of material for analysis. The procedure for taking a smear in pregnant women does not differ from that in the absence of pregnancy.
• A smear on the flora of men is taken quite quickly - literally in a couple of minutes. A thin probe is inserted into the urinary tract, about 4 cm deep, after which it is removed by rotation.
• A swab from the nasopharynx is performed simply, with the help of a cotton swab, which is injected into the nose or into the throat area and pressed against the mucosa.
• A smear from the ear is taken with a cotton swab and applied by rolling onto a laboratory glass. Separately, a stick and glass for the left and right auditory meatus are used.

Normal performance

In the vaginal cavity in the norm there should be quite a lot of varieties of microbes, which constitute a normal vaginal flora. The largest part of such microorganisms is lacto and bifidobacteria, living on epithelial tissue. Such bacteria produce acidic and alcoholic compounds, through which an acidic vaginal fluid is maintained. A considerable value among other microflora have enzymes - for example, lysozyme, which prevents the propagation of pathogenic microorganisms.

Further in the table we will display the types and number of microorganisms living in the norm in the composition of the vaginal microflora:

Representatives of the flora	The number, which is determined by CFU / ml
Bifidobacteria	From 10 3  to 10 7
Lactobacillus	From 10 7  to 10 9
Clostridium	Not more than 10 4
Staphylococcus aureus	From 10 3  to 10 4
Corinobacterium	From 10 4  to 10 5
Peptistreptococcus	From 10 3  to 10 4
Propionobacteria	Not more than 10 4
Mobilunkus	Not more than 10 4
Streptococcus	From 10 4  to 10 5
Enterobacterium	From 10 3  to 10 4
Bacteroid	From 10 3  to 10 4
She turned over	Not more than 10 4
Porphyromonad	Not more than 10 3
Candida	Not more than 10 4
Ureaplasma	Not more than 10 3
Mycoplasma	Not more than 10 3
Fusobacterium	Not more than 10 3
Veylonella	Not more than 10 3

This parameter CFU indicates the number of units capable of forming colonies in a milliliter of nutrient medium.

[10], [11], [12]

The device for analysis

A smear test on a microflora (using a slide) is a laboratory analysis that is based on the examination of a biomaterial under a light microscope. A special device for analysis is not required - it is enough to have a high-quality optical device that visualizes the smallest details in the smear. The main indicators of a qualitative microscope are the corresponding optical magnification, the presence of necessary attachments and illumination devices.

With the help of a good microscope it is possible:

• characterize the microflora in the area under investigation;
• to see the presence of inflammation, to evaluate its degree;
• identify the immediate causative agent of the disease, or detect indirect evidence of the presence of a specific microorganism.

In order for the analysis to be carried out as high as possible, it is necessary to take the material in a clinic that has been tested - it can be a public or private medical institution. The quality of research should be supported by such factors:

• adherence to all preparatory stages before the seizure of the biomaterial;
• availability of modern equipment and quality reagents;
• availability of appropriate specialists - both doctors and laboratory technicians.

How much is a smear in the flora?

There is no single answer to this question. The length of the waiting period depends on the site in which the material was seized and which agent is cultivated. Thus, the answer can be ready in 1-3 days, less often - after 7 days, and in some cases - even for two weeks (if there is a need to re-sample to other media).

More precise information on the terms of expectation of results should be requested in the clinic, where the treatment for the smear extraction was received.

Raising and lowering of values

The form with the result of the analysis can be passed directly to the treating doctor: he will also be engaged in deciphering the indicators, diagnosing and prescribing the treatment. But in some cases, the form is issued "in the hands" to the patient, who has a number of legitimate questions, for example: how to understand the information provided? What can these figures and letters mean, are they all right with me?

Of course, it is better to make an appointment with a doctor who will explain the results of the study in detail. If, however, the desire to sort out independently does not go away, one can turn to the following illustrative interpretations:

• The absence of flora in the smear is extremely rare and in the overwhelming majority of cases indicates prolonged treatment with powerful antibiotics. Modern antibacterial drugs can destroy not only pathogenic, but also healthy flora. The absence of microorganisms in the smear requires a long and painstaking restoration of the bacterial balance.
• A large number of flora in the smear can be both normal and pathological. It all depends on which flora prevails - healthy or disease-causing. A large level of pathogenic microorganisms, a lot of mucus and epithelial cells indicate an inflammatory process: this condition requires compulsory therapy. Urgent treatment is prescribed for the mass reproduction of pathogenic flora, in the presence of specific bacteria that cause certain diseases - for example, gonorrhea or trichomoniasis.
• Leukocytes in the smear on the flora are always present, since it is these cells that primarily protect the mucous tissues from penetrating the infection. The norm of leukocytes in the smear on the flora is 15-20 (in the urinary duct to 5, in the vaginal cavity - up to 10, and in the cervix - up to 20 units). When pregnancy is allowed to increase this level by another 5 units. If the number of leukocytes exceeds the permissible norm, then the presence of an inflammatory process in the tissues is most often suspected. After additional studies, the doctor makes a diagnosis of vaginitis, colpitis, cervicitis, etc. In severe inflammatory reactions, the leukocyte number increases several times - for example, in patients with gonorrhea or trichomoniasis, a particularly large number of such cells are detected.
• Erythrocytes in a smear on the flora of a healthy person should be absent. The reasons for the detection of red blood cells can be as follows:

1. mechanical damage to the mucosa at the time of swabbing;
2. presence of the active phase of the inflammatory process;
3. the presence of benign or malignant processes in the tissues.

For clarification, other auxiliary diagnostic methods are usually used. If you suspect a mucosal injury during medical manipulations, take the smear again.

• A flat epithelium in a smear on the flora is necessarily present if the examined woman is of childbearing age. With a sharp change in the hormonal balance, as well as in menopause, the number of epithelial cells in the smear decreases. With the advent of the menopausal period, the material mainly reveals the lower-laginal vaginal epithelium, represented by basal and parabasal cells. If such cells appear in the smear of patients of reproductive age, this may indicate a high content of male sex hormones, or a pronounced inflammatory process.
• Cylindrical epithelium in the smear on the flora can be detected only if the material is taken from the cervical canal. The fact is that the mucosal tissue of the urogenital tract consists of a flat epithelium, and the cylindrical is present only in the cervical canal. Any change in the number of cylindrical epithelium indicates cardinal disorders in the hormonal balance of the patient, or on the development of the inflammatory process.
• Slime in the smear on the flora is normally present in the vagina and cervix - in small amounts, but in the material taken from the urethra, mucus should not be. Usually an adequate level of mucus is described as a moderate or meager amount of mucus. The pain of mucus in a smear on the flora indicates a greater likelihood of the inflammatory process, but is not its one hundred percent sign, therefore this indicator is considered only in conjunction with other laboratory values.
• Often, as a result of research indicate a concept such as phagocytosis. This process is the detection and destruction of disease-causing microorganisms by leukocytes. Phagocytosis in the smear on the flora is mostly incomplete, as evidenced by the large number of unprocessed bacterial cells inside the leukocytes. This can be observed when joining the infection, as well as after stress and against a background of eating disorders.
• Cytolysis in the smear on the flora indicates the presence of a non-inflammatory reaction in the vaginal cavity. Such a reaction occurs due to the increased activity of a particular variety of lactic acid bacilli that release hydrogen. An uncontrolled increase in the number of such bacilli causes a shift in the vaginal environment to the alkaline side, with further cytolysis (decay) of the epithelial cells.
• An infrequent component in the smear can be fibrin, a protein substance present in the blood plasma. Fibrin in the smear on the flora indicates the development of an inflammatory reaction in the tissues.
• Detritus in the smear on the flora means the total number of residual microorganism particles and dead cell structures that have accumulated due to various processes on the mucous tissues. In small volumes detritus is present on the skin and mucous membranes, in the intestinal cavity. If a significant amount of detritus is found, this indicates a sharp and massive death of a large number of microorganisms in one area. This happens when taking large doses of antibiotics, with allergic processes, with a sharp imbalance of microflora.

Types of flora in the smear

• Kokkovaya flora in the smear is also allowed - in a small amount. These microorganisms - cocci - differ in a spherical configuration. In no case should they be greater than Dodderlein's sticks: a similar situation indicates a pronounced weakness of the immune defense or the development of an inflammatory reaction. Kokki can be Tp (+) and Tp (-). The first include enterococci, staphylococci, streptococci, and the second - gonococci.
• Kokkobatsillarnaya flora in the smear, in the first place, is found with vaginal dysbiosis, against the background of a decrease in the number of lactobacilli. Coccobacilli are microorganisms, which in shape resemble something between cocci and bacilli. To this kind of bacteria include hemophilic rod, gardnerella, chlamydia.
• The rod-like flora in the smear is normally represented by lactic bacteria. There should be many such bacteria, which means the presence of an adequate hormonal background and the absence of inflammatory processes. The vaginal epithelium produces glycogen, which serves as a nutrient for the Dodderlein sticks - the so-called lactobacillus. In the course of glycogenous decomposition, lactic acid is released, which ensures the constancy of the acid medium in the vaginal cavity. This environment serves as a natural protective barrier against many infections. With insufficient sticks, the vaginal environment becomes more alkaline: in a similar situation, a diagnosis of vaginal dysbiosis is made.
• Polymorphous-stalk flora in the smear denotes the presence and number of different types of microorganisms in the seized material. The norms of this indicator are relatively relative, as it is not considered in itself: it is taken into account in conjunction with other laboratory features, which allows to confirm or disprove the probable pathology.
• In healthy patients, an adequate vaginal swab is represented mainly by lactobacilli - acidophilic Gr. (+) Microorganisms. However, in addition to them, there are other varieties of bacteria on the walls, this so-called mixed flora, which may include various opportunistic microbes. Mixed flora in the smear in patients of the reproductive age increases immediately before and after menstrual bleeding, or in violation of the function of the ovaries. Changing the hormonal balance can also lead to the emergence of mixed flora in girls and women in the menopause.
• Soor in a smear on the flora is an indicator indicating the presence of candidal infection (thrush). A positive soor requires the appointment of an antifungal treatment.
• Lactomorphotypes in the smear on the flora should be detected if the material was taken from the vagina or cervix. Lactobacilli in the smear from the urethra are normally absent. If the vaginal swab contains a large number of lactomorfotypes (lactobacilli), then the microflora is considered qualitative. If lactobacilli is small, then measures should be taken to restore the normal microbial balance.
• Blastospores in a smear on the flora indicate the presence of candidiasis or other fungal lesions, which are treated like a thrush.
• Fungi in the smear on the flora can be found in the form of a mycelium and spores, which usually happens in candidiasis (all known thrush). If candida in the smear on the flora is found in the form of a dispute, then it can talk about a hidden thrush (the so-called "sleeping" infection). At the slightest infringement of immune protection the fungal infection becomes more active, and the thrush becomes aggravated: in this case full micellar filaments are found in the smear.
• Pathogenic flora in the smear is the presence of microorganisms that cause a certain disease. That is, if the diagnosis indicates the presence of pathogenic bacteria, the pathology is unequivocally present.
• The conditionally pathogenic flora in the smear, unlike the pathogenic representatives, does not in all situations mean the presence of the disease. Conditionally pathogenic microorganisms (for example, cocci) are capable of provoking the development of the disease only under favorable conditions for them - for example, with a pronounced decrease in immunity.
• Mycelium in a smear on the flora indicates a fungal infectious process. Mycelium is the most active form of the fungus, while spores are its inactive species. Spores in the smear on the flora can be present in healthy patients, but the mycelium - only with candidiasis.
• Filaments of pseudomycelia in the smear on the flora speak of increased candida reproduction. Pseudomicelium has the form of strands consisting of elongated cellular structures and blastospore. Typically, the study identifies pseudomycelia only in the acute period of candidiasis.
• Key cells in the smear on the flora can be represented by epithelial cells surrounded by small sticks. On a healthy mucosa such elements are absent. But with the pathology of the appearance of key cells suggests that aerobic lactic acid microorganisms were suppressed by anaerobes, in particular - the smallest rod-like flora. In a similar situation, the diagnosis indicates the presence of microbial vaginosis.
• Aerobic flora in the smear can be represented by staphylococci, E. Coli, streptococci - microorganisms, for the development of which the presence of oxygen is necessary. Usually such microbes are present mainly on the outer sexual sphere and in the intestinal cavity, and into the vaginal cavity fall in case of non-observance of intimate hygiene, or with unprotected anal-vaginal sexual contact. The presence of aerobes in the smear often indicates the development of aerobic vaginitis.
• Staphylococcus in the smear on the flora is allowed to be present and normal, but not more than 5% of the total amount of microflora. With an increased content of staphilococcus against the background of a decrease in the level of lactobacilli, they speak of an inflammatory reaction in the vagina or cervical canal.
• Dipteroids in the smear on the flora, found in small numbers, do not cause problems. However, with other violations of the microbial balance, these microorganisms are capable of causing pathology. Diphteroid flora in the smear is usually represented by microbes that are similar to diphtheria rods. Excess of their number is considered a sign of microbial vaginosis.
• Gardnerella in a smear on the flora is detected with vaginal dysbiosis, or so-called microbial vaginosis. Gardnerelli are the smallest sticks causing such an infectious pathology as gardnerellez. The admissible maintenance gardnerelly in a smear - no more than 10 ⁵  .
• Leptotriks in the smear has the appearance of the finest gram-negative microorganism. Leptotrix itself does not cause a disease, but it can accompany other infections - for example, it is often found against the background of trichomoniasis, candidiasis, chlamydia, and with the usual imbalance of the vaginal flora.
• Gonococci in a smear on the flora can be found both in the urethra and in the vaginal cavity. The presence of these microorganisms indicates infection with gonorrhea - a disease that passes sexual transmission. The disease requires unequivocal treatment, with the course of therapy being performed by both sex partners.
• Corynebacteria in the smear on the flora can be present in a safe amount. This is a kind of gram-positive rod-shaped microbes, better known as pathogens of diphtheria. Inside the vagina these bacteria sometimes get out of the intestine and in large quantities can cause inflammation.
• Actinomycetes in the smear on the flora usually lead to a disease - actinomycosis, caused by radiant fungi. Actinomycetes are able to inhabit the mucous membranes of the mouth and eyes in the form of saprophytic flora, and under favorable conditions - for example, against the background of the inflammation reaction, fungi become active, actinomycosis develops.
• Trichomonas in a smear on the flora can become a causative agent of vaginal trichomoniasis. Such microorganisms are bulk unicellular bacteria equipped with flagella. With trichomoniasis, a lab technician can detect both whole cells and destroyed microbial particles. Both in the first and in the second situation they speak about the presence of trichomonas infection.
• Enterococcus in a smear on the flora can be contained in a certain amount - this microbe is related to opportunistic pathogens, therefore, with adequate immunity and absence of provoking factors, it should not be feared. With active multiplication of enterococci, there is an enterococcal infection - this pathology is usually treated with antibiotics prescribed by the doctor after analysis for the sensitivity of the flora. The difficulty is that such an infection often has an increased resistance to many modern antibacterial agents. Therefore, it is necessary to clearly know which antibiotic will help in a particular situation.
• Chlamydia in a smear on the flora is often found simultaneously with mycoplasma and ureaplasma. Large amounts of these microorganisms can disrupt the function of the reproductive organs and cause infertility. For confirmation of chlamydia and determination with further therapeutic tactics, it is necessary to carry out additional diagnostics using PCR and ELISA.
• Intestinal sticks in the smear on the flora are allowed in small amounts. However, when bacteria multiply, problems arise, such as microbial vaginosis and other diseases. Pathology is usually cured completely, without further complications.

[13], [14]

How to treat flora in a smear?

It should be noted that the flora itself does not need treatment: therapeutic procedures can be prescribed to the patient if the pathogenic flora becomes dominant, leading to the development of various diseases. Sometimes it is enough to conduct a course of normalization of microflora - for example, with preparations containing useful microorganisms (lactobacilli, live yoghurt cultures, probiotics, etc.).

Such pathologies as gonorrhea, mycoplasmosis, trichomonas and chlamydia lesions always require treatment with special medications that affect the corresponding group of microorganisms. Treatment can be complex - injections, oral preparations, suppositories, ointments, irrigation. In light cases it is possible to use only suppositories or creams.

The decision on the appropriateness of the therapy, as well as the scale of treatment, is made by the attending physician on the basis of the analyzes and the available clinical picture.

Than to treat a cocci flora in a smear?

The treatment consists of the local use of medication, within 7-14 days. Most often in gynecology, Betadine is used, but contra-indications and side effects (for example, itching, irritation of the vaginal mucosa) are taken into account when prescribing.

Any widespread coccal flora requires the use of antibacterial medicines - Clindamycin, Metronidazole. Such drugs can be presented in any convenient dosage form: from tablets and aerosols to suppositories and creams.

In addition, the doctor may prescribe medications to activate immune defense, as well as probiotics.

If there are complaints of uncomfortable sensations such as itching and burning, then antihistamines, antifungal medications (prescribed immediately after antibiotic therapy) are included in the treatment.

With a minor cocci lesion, a doctor can do without antibiotics, replacing them with solutions of antiseptics (for example, a solution of Chlorhexidine), as well as preparations for oral administration (for example, suspension of Lactobacillin). In addition, women should perform syringing with infusion of calendula, chamomile, celandine.

How to restore flora in a smear?

The initial stage of the restoration of the flora is to render harmless the pathogenic microorganisms. For purification of mucous tissues from "superfluous" bacteria the doctor often prescribes preparations of local influence - these can be vaginal suppositories or tampons impregnated with medicinal solutions. Individual patients need to take additional antifungal drugs.

The second stage in the path of stabilization of microflora is its saturation with lactobacilli and other microorganisms that make up the healthy flora. For this purpose, special preparations are prescribed, with simultaneous laboratory control of the normalization process.

We must not forget that retention of flora in normal limits is impossible with persistent impairment of immunity, primarily at the local level. Therefore, many patients should additionally take immunocorrective drugs - for example, suppositories with immunomodulating properties. Sometimes such treatment is performed immediately before antibiotic therapy.

For a complete process of stabilizing the flora, one month is usually enough. This must be confirmed by laboratory tests - that is, upon completion of the course of therapy, the patient repeatedly checks the flora in the smear.

Treatment of elevated white blood cells in a smear for flora

The norm of leukocytes in the smear on the flora is dependent on the zone where the material was seized. Usually only a small number is allowed in the smear - up to 15-20 (in the urinary duct to 5, in the vaginal cavity - up to 10, and in the cervix - up to 20 units). This index increases sharply in the reactions of inflammation (colpitis, urethritis), and the more it is, the more acute the inflammation reaction. Also, a slight increase in the value during pregnancy - for example, on the walls of the vagina can be detected up to 15-20 units, and this will be considered a variation of the norm.

If there is inflammation, the doctor will prescribe anti-inflammatory therapy. Preparations are selected, depending on the general characteristics of the obtained laboratory results. Typically, treatment is cumulative and includes local effects, general therapy and the subsequent restoration of adequate flora.

Locally appoint douching (4-5 days) Chlorhexidine, Miramistin, infusions of herbs (chamomile color, sage, calendula). It is recommended to introduce vaginal suppositories with anti-inflammatory effect: the choice drugs often become Hexicon, Betadin, Polizhinaks, etc. If a fungal infection was detected in the smear, the doctor will advise using antifungal suppositories such as Clotrimazole, Livarol, Pimafucin, etc. Such a suppository should be administered 1- 2 times a day, and the course of therapy can be 1-2 weeks.

If laboratory tests indicate the presence of viruses, causative agents of sexually transmitted diseases, latent sexual infection, then there is a need for systemic antiviral or antibacterial therapy.

The final step for successful treatment is the restoration of microflora. Vaginal suppositories or tampons impregnated with probiotic solutions are used. Oral administration of restorative drugs is also possible for ½-1 month. At the end of the therapeutic course, a control evaluation of the flora in the smear is carried out.