Bacterial and non-bacterial flora in a smear

The normal microflora of the female genital tract is distinguished by species diversity with predominance of anaerobic microorganisms of Aeroba, which for active life requires air, if they are found in a smear on the flora, then in small quantities. An increase in their content indicates a violation of the vaginal environment, an imbalance of beneficial and harmful bacteria.

Typical representatives of anaerobes include Doderlein bacilli, or lactic acid bacteria, due to which an acidic environment is maintained in the vagina, which is harmful to pathogens. A large number of lactobacilli helps to restrain the penetration and reproduction of other, not useful anaerobes, which are suitable environment without access to air, gardnerella, as well as coccal microflora, constantly living on the human body. Activating and multiplying, the pathogenic microflora in the fight for food begins to inhibit the growth and reproduction of beneficial lactobacilli, which is not hampered even by the introduction of the latter from the outside in the form of therapeutic candles.

The coccal flora in a smear, whose representatives are spherical in shape, can be represented in all the richness of its species. Normally, cocci along with other opportunistic and neutral microorganisms in the vagina are present in a total volume of not more than 5%. But with a weakening of the immune defense, an excessive passion for intimate hygiene, the use of medicines that negatively affect lactobacilli, the balance of microorganisms in the vagina is disturbed.

In the struggle for survival, some pathogens themselves begin to exterminate the lactic acid flora. Thus, the enterococci found in the smear, as the most aggressive anaerobes, can significantly reduce the population of Dederlein's rods.

Most often, smears reveal fecal enterococcus, which can get into the vagina as a result of insufficient intimate hygiene or during sexual intercourse. The bacterium is found in 25% of women, but with a small number of bacterial cells is not dangerous. When immune protection is weakened, enterococci can not only actively reproduce, but also destroy useful microflora.

Moreover, settling in the vagina, they can move in the direction of the urinary system, provoking inflammatory processes with severe pain. It is not so easy to detect enterococci due to their similarity with streptococcal infection, and it is even more difficult to cure. They are sensitive to a small group of antibiotics, and they usually only reduce the number of bacteria.

Streptococci and staphylococci are gram-positive microorganisms that constantly live on our skin and mucous membranes, and sometimes penetrate into the body, so it is not surprising that in small quantities these bacteria are found in the composition of the normal vaginal microflora. They are referred to as aerobic and optionally anaerobic bacteria that can live either in the air (oxygen is not harmful for them, for true or obligate anaerobes), or without it.

The increase in the number of streptococci and their predominance over the useful lactic rods of Doderlein against the background of moderate leukocytosis (leukocytes not more than 50 in sight) indicates an imbalance of the microflora (vaginal dysbacteriosis). In itself, this condition is not considered a full-fledged disease, but it can cause the reproduction of another pathological microflora (gardnerell, fungal flora), i.e. The development of bacterial vaginosis, in which Gardnerella and other anaerobes predominate, and the number of lactobacilli is extremely small, and candidiasis (a fungal disease of nature).

It must be understood that streptococcal vaginal infection is not dangerous per se, either for a woman or for her sexual partner with normal immunity. But it can be dangerous to the fetus if the woman is pregnant. Infection can occur both when the infection is introduced through the placenta (these are pathologies of a child’s development, often miscarriages at different periods), and during the passage through the birth canal (inflammatory diseases of the lungs, brain, blood poisoning).

Identical situation when detected in a smear on the flora staphylococcus. It is also representative of opportunistic microflora. If its content in the vaginal environment less than 1% is not worth worrying about. Yes, and a small increase in the number of bacteria without an increase in the number of leukocytes is not considered a cause for concern, therefore, it is necessary to consider a staph infection only in conjunction with counting the number of leukocytes.

The excess of the number of conditionally pathogenic coccal microflora without an increase in the level of white blood cells indicates a non-inflammatory pathology - vaginal dysbacteriosis. But already an increase in the content of leukocytes indicates an inflammatory disease, the progression of which can be judged by the degree of leukocytosis.

In terms of the development of purulent-necrotic processes, golden and hemolytic staphylococcus are considered the most dangerous. The latter is much less common than other staphylococcal species. But otolaryngologists quite often encounter Staphylococcus aureus, diagnosing otitis, purulent forms of tonsillitis and some other infectious diseases of the ear, nose and throat.

Active staphylococcal infection in the vagina can be suspected already by purulent secretions of yellowish or greenish color, but visual assessment is not enough to make a final diagnosis.

The fact is that the activation and reproduction of conditionally pathogenic coccal microflora may be evidence of the penetration into the body and the parasitism in it of sexually transmitted pathogenic bacteria. At the same time, purulent discharges can also be detected, but the causative agent of the disease will be different, and therefore the approach to treatment should be different, not to mention the prevention of infection.

Another representative coccal flora is gonococcus. This is a Gram-negative round bacterium of the genus Nesseria (Neisseria gonorrhoeae). Unlike streptococci, staphylococci and enterococci, which are representatives of conditionally pathogenic microorganisms, gonococcus is considered a true parasite. In a smear on the flora gonococci should not be present at all, because they are not permanent residents of our body. If they are found, then we are talking about sexual infection.

Gonococcus is the causative agent of STIs called “gonorrhea”, which is characterized by purulent inflammation, most often in the area of the genitourinary system. Similar to enterococci, under the conditions of the vaginal environment, these bacteria are quite resistant to various influences, easily adapt to changing conditions of life and quickly develop resistance to antibiotics. But outside the body, they die even with moderate heating or drying of the nutrient substrate, they are afraid of soapy water and most antimicrobial agents.

If the body is able to cope with conditionally pathogenic microflora on its own through the production of neutrophils and other cells of the immune system, the pathogenic flora in the smear is a great danger and it is impossible to cope with it without outside help. Even after absorption by neutrophils, gonococci remain viable and can multiply.

We considered representatives of coccal microflora, which can be found in smears in women, but in reality, even in a normal vaginal environment, about 100 species of microorganisms coexist, having different shapes and sizes.

In addition to spherical bacteria, elongated microorganisms can be detected in the vaginal discharge; in the form of sticks. This form is characteristic of bacilli, which include Dederlein's sticks.

But the flora in the vaginal smear may be more diverse, which is not an optimistic symptom. The discovery of a small number of small-legged organisms in the discharge of the genital organs can hardly be considered a cause for concern, especially if any symptoms of indisposition are absent. But abundant small-plop flora can be evidence of vaginal dysphagia or dysbacteriosis.

Gardnerella, as a representative of conditionally pathogenic facultative anaerobes, is often found in a smear on the flora, given that many of us only have a strong immune system because of constant stress, malnutrition, chronic diseases and other negative external and internal factors.

Small bacteria in the form of sticks do not pose a particular danger, but they can undermine the body's defenses, creating an environment for reproduction and growth of chlamydia, gonococci, and trichomonads. Gardnerellosis by itself does not apply to sexually transmitted infections. Bacteria can be detected even in those who are not sexually active, but have been influenced by factors that weaken general and / or local immunity. In men, the disease is usually asymptomatic, and women are diagnosed with bacterial vaginosis, which is accompanied by appropriate symptoms: poor discharge (white, yellowish or transparent) with an unpleasant fishy smell.

In connection with gardnerellezom often referred to as the phrase "key cells". It is this phrase that marks a somewhat unusual disease that some doctors are trying to actively heal, while others actually ignore it. The key cells are called particles of the squamous epithelium with a small microflora called gardnerella, attached to them.

The key cells in the smear for flora are direct evidence of bacterial vaginosis caused by the rod microflora (gardnerella). In men, such cells on the penis can be detected only after sexual contact with a woman who has active gardnerella in the vagina. With a weakened immune system, Gardnerella is attached to another flora of the penis and can cause bacterial balanoposthitis (inflammation of the head of the penis), especially if the bacteria accumulate under the foreskin due to poor or irregular intimate hygiene.

In addition to the sticks of Doderlein and Gardnerell, other bacilli are also part of the normal microflora of the vagina, which differ in the size and shape of the sticks, but are still smaller than lactobacilli. Polymorphous-rod flora in a smear is always present, but the danger is only when it is increased in concentration, because actively reproducing, they begin to suppress the beneficial rod microflora.

The rods of different sizes and shapes can provoke the development of various non-inflammatory diseases (dysbacteriosis) and inflammatory nature, while the woman’s vaginal discharge increases (white, gray, greenish, sourish), itching, discomfort during urination, pain during time of sexual intercourse, discomfort in the lower abdomen. These symptoms are similar to a fungal infection (candidiasis), which causes an erroneous diagnosis during self-diagnosis. Examination of the smear avoids such errors in the diagnosis and, accordingly, in treatment.

The bacillus also belongs to the rod microorganisms that can be found in humans. This is a gram-negative bacterium, most strains of which are harmless, and some even benefit. Living in the intestines, they produce vitamin K and help fight disease-causing bacteria.

But E. Coli is useful only for the intestines, and getting into other organs can cause various inflammatory diseases (peritonitis, prostatitis, colpitis, vaginitis) or complicate the course of existing infections, therefore E. Coli in a smear on flora is considered to be a bad symptom. Normally, this microorganism should not be present in the vagina or urethra, which is possible only if hygiene of the genital organs is observed.

Corynebacteria, which are rod-shaped gram-positive anaerobes, can also be found in a smear on the flora of a healthy woman. It must be said that this bacterium has several varieties, among which are safe and pathogenic. In the vagina, Corynebacterium normally coexists with other microorganisms, and an increase in their number is observed only with dysbiosis. They themselves usually are not the cause of the disturbance of the biocenosis, but they actively reproduce on the soil prepared by other pests and displace useful lactic acid bacteria. Corynebacteria emit in 60-70% of cases of urogenital infections, although by themselves, being representatives of conditionally pathogenic microflora and living in the body of a healthy person in decent quantities, they are not able to provoke a serious disease.

But Corynebacteria found in a throat or nasal smear no longer seem harmless, because some of its types are causative agents of a serious and dangerous disease - diphtheria, and other non-diphtheria strains (diphtheroids) can cause acute inflammatory diseases of the upper respiratory tract, pharyngitis, otitis, lymphadenitis.

Difteroids can also be found in a smear on the flora taken from the vagina, and in small quantities are not dangerous. They are often found in the epithelium of the vagina of little girls, and in the nasopharynx, along with staphylococci, they constitute the bulk of the microflora.

Difteroid flora in a smear is dangerous if it, together with other pathogens, predominates over beneficial lactobacilli. If lactobacilli in the vagina is sufficient, the concentration of opportunistic microflora is unlikely to rise to a critical level. In the respiratory tract, dipteroids can multiply only against the background of a marked decrease in immunity, along with staphylococci and other inhabitants of the respiratory system.

Sometimes the results of smear on flora can cause some confusion. For example, the phrase “coccobacillary flora in a smear” can be confusing, because we know that cocci are round-shaped bacteria, and bacilli are rod-shaped microorganisms. So who are coccobacilli?

Coccobacilli is a group of bacteria whose shape is intermediate between a ball and a rod. These are oval bacteria of a slightly elongated shape, which include the hemophilic bacillus (found in smears from the pharynx and nose with the flu), gardnerellas (we wrote about them above), chlamydia (the causative agent of chlamydia), the tibia aggregate and actinomycetecomitance (causes severe gum inflammation).

We will dwell on coccobacil parasites on the genitals. If it is considered by many doctors to be an unserious infection, then you cannot say so about chlamydial infection, although a prolonged absence of marked symptoms of the disease may predispose to this. But doctors know how dangerous chlamydia is.

Chlamydia in a smear on the flora is not so easy to detect, because these bacteria have some properties of viruses. They invade a living cell and parasitize inside it, after which the cell becomes unviable, and the bacterium changes its place of residence. Under a microscope, bacteria can be seen only when exposed to a biomaterial with special coloring agents, but there is a high probability of a false result. PCR analysis is considered to be the most reliable method for determining chlamydia, so if you suspect chlamydia, doctors prescribe this rather expensive but reliable research.

The danger of chlamydia is that the infection causes severe inflammatory processes and often proceeds in a chronic form, significantly weakening the body. Moreover, prolonged inflammation causes the formation of adhesions in the vagina and narrowing of the urethral canal, which causes infertility in women and men.

Another danger is the spread of infection to the uterus, the development of inflammatory and dysplastic processes, which further reduces the chance of getting pregnant and carrying the child, but it increases the risk of cancer. In both women and men, chlamydia can go to the organs of the urinary system, joints, liver, peritoneum, etc., causing serious severe and long-lasting inflammation.

In pregnant women, chlamydia can cause ectopic pregnancies, miscarriages, arrest of fetal development, early delivery. Infection of the child during childbirth is fraught with the development of otitis media and conjunctivitis, and if the bacteria continue to remain in the body, problems with the heart, nervous and digestive systems are possible. For girls, chlamydia infection at an early age is fraught with infertility in the future.

Unusual flora in the smear

Chlamydia is an insidious infection that can be asymptomatic for a long time, and if symptoms appear (in the form of yellowish discharge, burning during urination, slight itching in the genital area), then it is slightly pronounced, and besides, they can disappear after a couple of weeks that does not mean recovery. Similarity to viruses in behavior makes it difficult to identify chlamydia, but another bacterium, leptotrix, can hint at their presence.

Leptotrix is a special type of Gram-negative bacteria, which have an unusual shape - in the form of thin threads that resemble a hair, with which the name of microorganisms is connected. Initially, these bacteria were attributed to the fungal microflora, but later they settled on the fact that these microorganisms are more similar to bacteria, in particular, lactobacilli, which explains the absence of changes in the acidity of the internal environment of the vagina when leptotrix is detected.

Leptortix in a smear for flora is found in the form of chains of different lengths (from 5 microns to 75 microns). They get along well with lactobacilli and in the early stages of the development of the disease do not cause tangible symptoms, so they can be detected by chance during a gynecological examination.

The infection is not sexually transmitted, and when bacteria are detected in men, it is not accompanied by any pathological symptoms.

Women in the first half of the cycle usually also have no complaints. They appear in the second half of the cycle and boil down to increased vaginal discharge (white or transparent, similar in consistency with water, odorless and lumps), itching and burning in the genital area and vagina, which occasionally increase during urination. At the same time gynecological examination does not show how noticeable hyperemia or swelling of the vaginal walls.

At first glance, such a bacterium does not seem dangerous, because we are not talking about the inflammatory process. But its ability to produce lactic and some other acids with active reproduction can increase the acidity of the vagina, and this is also not good, as well as its decrease. With increased acidity of the internal environment may damage the cells of the mucous membrane and nerve endings, which may cause incomprehensible pain in the vagina (vulvodynia).

In addition, leptotriks, the appearance of which is associated with improper treatment of thrush and a decrease in local immunity, is often a signaling device for other infections, since often combined with fungal infection (candidiasis), chlamydia, trichomoniasis, gardnerellosis.

Another bacterium similar to leptotrix is similar in its structure — leptotrichia, but the symptoms will be somewhat different: the discharge becomes abundant, acquires a grayish tinge and an unpleasant odor, besides itching and burning in the vagina, pain is also noted during sexual intercourse, and studies show an increase in pH vagina, i.e. Reducing its acidity. That is, we are dealing with one of the varieties of bacterial vaginosis that requires appropriate treatment.

In addition, one of the rare species of leptotrichia can cause various complications of pregnancy in expectant mothers. Such a flora in a smear can cause inflammation of the membranes of the fetus, inhibition of its development, premature birth, sepsis in weakened mothers, etc.

Actinomycetes have some similarities with leptotrix and leptotrichia in their structure. These facultative anaerobes, which can live both on and without air, have the appearance of the finest sticks with thickened edges, forming filaments of different lengths (up to 50 microns). Because of their ability to form a developed mycelium (by analogy with fungi), they were also originally attributed to fungal microflora, but it turned out that these microorganisms are more similar to bacteria.

This fairly common type of bacteria can be found in the soil, including sand (up to 65% of the entire microflora), and in water (tap, spring, from sources), and on plants. It is not difficult for it to penetrate into the human body during a meal or hygienic procedures, but this does not mean that the person is sick. The fact is that actinomycetes are not able to penetrate healthy skin and mucous membranes. Another thing if there was injury to the skin.

Actinomycetes in a smear for flora in small quantities can be found in healthy people, but with normal protective function of the skin it does not matter. But in case of damage to the skin or mucous membranes on the background of a weakened immunity, the development of a non-specific inflammatory process is quite possible. So women begin to complain of pain in the lower abdomen of different localization, a sharp rise in temperature up to 40 degrees (most patients).

Most often, appendages are involved in the inflammatory process. First, it is a simple inflammation. Further, infiltrates in the form of seals appear, fistulas with purulent discharge can occur, multiple adhesions in the pelvic region, problems with conception occur.

Despite the fact that actinomycosis is not diagnosed so often, the consequences of the disease are far from attractive, so even a small increase in the number of these unusual bacteria should alarm the physicians, especially since conventional anti-inflammatory therapy (antibiotic therapy, use of sulfa drugs, surgical treatment) provide only short-term results and thermal physiotherapy treatment only aggravates the situation. Only a comprehensive treatment taking into account the clinical picture, the characteristics of the course of the disease and the individual characteristics of the patient's body gives positive results in the treatment of this resistant to the effects of infection.

Nonbacterial flora in the smear

Considering the different types of flora in the smear, it is worth noting that coccal, rod and filamentous bacterial microflora is not the only possible one in the conditions of the female vagina. Other microscopic organisms can also penetrate there, for example, fungi and Trichomonas - unicellular parasites, which cannot be attributed to either bacteria or viruses or fungi.

Trichomonas refers to pathogenic, i.e. Pathogenic microflora, therefore, the detection of it in a smear on the flora does not bode well. The disease itself, triggered by trichomonads, is called trichomoniasis and belongs to the category of venereal diseases. It is clear that the infection is sexually transmitted, while the disease is considered very contagious, therefore, when detecting Trichomonas from one of the sexual partners, it is necessary to have the examination and the other.

Trichomoniasis is one of the most common STIs. This is due to the high level of infectiousness and often insufficient attention to it from doctors and patients. The Trichomonas themselves are very active microorganisms, prone to moving quickly, preferring a moist environment without air access, so they feel very comfortable in the female vagina or urethra (in men, the disease usually affects this part of the sexual organ).

About trichomoniasis in women say these symptoms:

• offensive frothy vaginal discharge, which may range from white or grayish to yellow or green,
• discharge may contain pus and is accompanied by itching and burning in the genital area.

Painful urination, aching pain in the lower abdomen, discomfort during sexual intercourse can also be symptoms of STIs in women. In men, the disease can occur without obvious symptoms or be accompanied by pain when urinating, signs of inflammation of the prostate, itching and burning after ejaculation, purulent and mucous discharge from the urethra, and frequent urination.

It must be said that in most men and in some of the women the disease has no symptoms for the time being. Sometimes such a hidden course can last for years, while the person all this time remains a source of infection.

But even the hidden course of the disease does not bode well, because it can cause infertility in men and problems with pregnancy in women, increases the likelihood of developing other sexually transmitted infections and HIV. Although the treatment of the disease is generally not difficult (one-time antibiotics are enough), the main thing is to identify it in time, which is easiest to do when examining vaginal smears and urethra.

In almost all cases, the vaginal microflora is distinguished by a noticeable variety of life forms. In other words, a smear shows a mixed flora, which contains a variety of bacteria, fungi, and in some cases microorganisms that occupy an intermediate position (the same trichomonads).

Yeast fungi from the Candida genus in a smear for flora are found in most women. They are considered representatives of conditionally pathogenic microflora and live in small quantities on our body (in the oral cavity, large intestine, vagina), without causing symptoms of the disease. The ability to actively multiply in fungi usually occurs against the background of long-term antibiotic therapy or a marked decrease in immunity (general or local).

It must be remembered that any microscopic wound on the skin or mucous membrane is already a serious flaw in the protective membrane of our body, because it is a nutrient medium for opportunistic and pathogenic microflora. This is one of the main factors reducing local immunity. And stresses, any chronic diseases, frequent infections, uncontrolled intake of certain drugs, therapy with immunosuppressants, etc., can undermine the general immunity.

Detection of mycelium (mycelium in the form of a developed network of filaments) or spores (reproductive cells of fungi) in a smear for flora suggests that the infection has begun to multiply rapidly. Despite the fact that both fungi and bacteria have the ability to spore formation, the expression “spores in a smear on flora” is most often used in relation to fungal microflora. If bacterial spores are one of the types of bacterial cell existence, which allows it to survive in adverse conditions, fungal spores are cells that serve to reproduce them. It is clear that in the second case there is a greater danger than the inactive existence of the microorganism.

Candidiasis, or thrush, is the most common fungal infection in humans, caused by oval or round microorganisms of the genus Yeast Candida fungi. In the process of vital activity, these fungi form numerous strands of pseudomycelium, formed simultaneously by maternal and daughter cells (unlike true mycelium, formed by budding rather than dividing) and blastospores (asexual reproductive cells of yeast fungi, the so-called kidneys), which are found in smear on flora during his research. This feature is characteristic of all yeast fungi, but most often we are talking about Candida mushrooms.

Candidiasis is a disease that is diagnosed in two cases: with the active reproduction of fungi or the detection of their pathogenic strains, which even in small numbers can provoke the disease, inhibiting local immunity. Candidiasis of the oral cavity and vagina is quite easy to detect using a smear from the corresponding area.

Fungal infection of the genital organs is more often diagnosed in women, because in the vagina for fungi optimal conditions are created for the reproduction of microorganisms: warm and humid, and it is worth only slightly correcting the internal environment of the vagina towards alkalinity, as fungi begin to actively proliferate and spread to healthy areas. In women, the fungal infection causes a candidal vulvovaginitis, in men, balanitis or balanoposthitis, characterized by inflammation of the tissues (hyperemia on the background of minor edema) and the appearance of a white, cheesy odorless smear (in women in the form of vaginal discharge). Also, patients may experience painful itching, burning in the genital area, pain during intercourse or urination.

In case of oral candidiasis, the tongue is first covered with white bloom, the skin of which acquires a bright red or burgundy shade and may burn slightly when eating food with a pronounced taste. The raid is quite easily removed from the tongue, so the taking of material for examination (smear or scraping) does not pose any particular difficulty.

Conditionally pathogenic flora in the smear, which includes many bacteria and fungi (for example, fungi that cause thrush), is considered as a symptom of the disease only if it is actively reproducing, which is determined quantitatively. But the identification of pathogenic strains even in small quantities is a cause for concern and a more serious examination, because the disease, captured at an early stage of development, is easier to treat and brings less harm to health. True, given that many opportunistic microorganisms live on our body constantly and completely get rid of them is impossible, a large role is given to the maintenance of immunity, which is an important point in the prevention of various infections.

[1], [2], [3], [4], [5]