What does a smear show on flora?

The result of a microbiological or cytological examination may be handed to the patient or sent to the doctor who prescribed the analysis (gynecologist, urologist, etc.). To record the evidence provided a special form of bacteriological or cytological examination.

Since the female genital organs are structurally and functionally different from the male, it turns out to be quite logical that the normal microflora of the penis in men and the vagina in women will differ somewhat, which will be reflected in the form with the results of the study.

So, normally a male smear may contain:

White blood cells (Le)	Up to 5 in sight
Red blood cells (Er)	Up to 3 in hollow vision
Eoinophiles (Eo or E)	Up to 10% of all cells
Squamous epithelium	Up to 10 in sight
Mixed opportunistic microflora

As part of the normal microflora in men, one can find epidermal, saprophytic and Staphylococcus aureus, neisseria, pseudomonas and E. Coli, green streptococcus, fecal enterococcus, Proteus, Corynebacterium, bacteroids. Some of the above microorganisms are not capable of causing diseases, others (conditionally pathogenic) - become dangerous only in large quantities (with active reproduction).

Sometimes a small amount of mucus may be present in a man’s smear. This happens with sexual arousal on the eve or during a smear, but may be a sign of an inflammatory process.

Now consider the composition of normal microflora microscopic examination of women:

Indicators	U	V	C
Leukocytes (Le)	≤ 10	≤ 10	≤ 30
Erythrocytes (Er)	Not	Not	Not
Square epithelium	≤ 10	≤ 10	≤ 10
Slime	Not	No (moderately)	No (moderately)
Other flora	No (n / a, not detected)	Lactobacilli (in large quantities or moderately)	No (n / a, not detected)
Key cells	Not	Not	Not
Candida	Not	Not	Not
Gonococci (Gn)	Not	Not	Not
Trichomonas (Trich)	Not	Not	Not

If a specific indicator in the biomaterial is not found in the analysis form, there can be a dash - (-) or the words “no”, “n / o”, “not detected”, etc.

Sometimes a form with test results instead of letters and numbers contains signs “+” or “-”. The latter indicates a negative result for a particular indicator, i.e. The absence of this type of bacteria or cells. By the number of "+" you can judge the prevalence of this type of microflora in the studied material.

Normal flora in a smear  in women does not mean the complete absence of various representatives of conditionally pathogenic microflora in it, just their number is insufficient for the development of inflammation, therefore, it is not even mentioned. The presence of mucus is not a pathology if it is present in moderation. Single leukocytes are also a variant of the norm, which only indicates the readiness of the immune system to fight back the infection.

The relative constancy of the vaginal microflora helps to maintain lactobacilli (Doderlein sticks, constituting about 95% of the normal vaginal microflora), which should be present in large quantities in a smear of a mature woman. They begin to develop in the body of girls as early as adolescence and are responsible for maintaining the acidic environment of the vagina. Eating glycogen, these beneficial bacteria produce lactic acid, which creates an environment in the vagina that is not suitable for the reproduction of unhealthy microorganisms.

Sometimes in the analysis form you can see the incomprehensible word "lactomorphotypes". This is another name for lactobacilli, and if lactomorphotypes in a smear on the flora of the vagina are present in large quantities (at least 90-95%), then the woman should not be afraid, but be happy, because it indicates a good condition of the vagina. This is the only indicator for which high values are considered an advantage.

But the decrease in the number of lactobacilli is already an alarming symptom, because it says about the violation of the vaginal microflora. Ideally, the rest of the inhabitants of the vagina (coccal and rod microflora, fungi, constantly living in our body) should account for no more than 5% of the total number of microorganisms. If lactobacilli becomes less, then the number and composition of other bacteria that are not beneficial to humans increases, and this already indicates a violation of the health of the female genital.

Lactobacilli are found only in the vagina, and in the urethra and cervical canal they are normally absent.

A large number of flora in a smear is considered a good sign when it comes to lactomorphotypes, but not about another rod, coccal or other microflora. Microscopic examination of smear material is difficult to determine the content of certain types of bacteria in it, therefore only their total number is taken into account. And if it is more than 5% of the total number of residents of the vagina, a woman should pay attention to their health.

The lack of flora in the smear is an unpleasant symptom in any case. The reason for the false result can be a thorough hygiene of the genital organs on the eve of the analysis, including douching and the use of antibacterial agents. But if a woman prepared to give a smear according to all the rules, but the analysis still showed the almost complete absence or a noticeable decrease in beneficial microflora without an increase in the disease-causing one, this could be evidence of prolonged antibiotic therapy in high dosages, which simply destroyed the natural protection of the female body and the reproductive system in particular.

This situation is extremely rare. Usually, when destroying lactobacilli and reducing the acidity of the vagina, fungal microflora begins to actively multiply, which does not die under the action of most antibiotics, and soor (fungi of the genus Candida) is detected in the smear on flora.

What is vaginal cleanliness?

We used to think that it is pure where there are no germs. But in relation to the female body, such a definition of purity is not applicable, because the absence of microflora in a smear is considered a violation, and such sterile purity should only be alarming.

Gynecologists, speaking of the true purity of the vagina, implying the presence in it of useful microflora and the absence of harmful, consider 4 degrees of such purity:

• 1 degree - the dream of any woman. This is actually an ideal model of the internal environment of the vagina, where beneficial lactobacilli (Doderlein sticks) dominate, no visible presence of other bacteria and fungi is detected, but the presence of single pure epithelial cells can be noted, the presence of single leukocytes is allowed. Characterized by the complete absence of mycelium of fungi and gram-negative microflora. In women who have sex, a similar vaginal flora in a smear is extremely rare. Usually such a smear result is noted after rehabilitation or a short course of antibiotic therapy.
• The 2 nd degree is a variant of a pure vagina, closer to reality, although here we cannot speak of true purity. A slight decrease in the number of lactobacilli, an increase in the content of epithelial cells and leukocytes in the biomaterial is characteristic. The presence of a small amount of gram-positive cocci and gram-negative rods, macrophages. This pattern is often found in healthy women, rarely accompanied by any specific complaints.
• 3 degree - here already it is not necessary to speak about cleanliness. The biomaterial has a significantly reduced lactobacillus content, other possible inhabitants of the vagina are found in moderate amounts: an anaerobic species of Comma variabile, gram-negative rods and cocci in moderate quantities, gram-positive cocci, colibacilli, and individual trichomonads can also be found. There is also a moderate leukocytosis, indicating the beginning of the inflammatory process or a sluggish disease. In this case, the unprofitable microflora prevails over the healthy one, which speaks of female ill health, i.e. Impaired biocenosis (vaginal dysbiosis, also known as bacterial vaginosis), which means additional examination and restoration of the normal vaginal environment is required.
• Grade 4 - an alarming situation when the smear does not show beneficial lactobacilli, and the power belongs to conditionally pathogenic and pathogenic (gonococci, trichomonads, gardnerella) microorganisms. A moderate number of epithelial cells and elevated white blood cell count indicates a pronounced inflammatory process. There is already a serious disease that needs to be treated without shelving.

Schematically, the assessment of the biocenosis (state of the microflora) of the female vagina can be presented in the form of a table:

Microscopic indicators	I	II	III	IV
Lactobacilli	+++	++	+	-
Variable paragraph	-	-	++	++
Gram-negative cocci / sticks	-	-	++	++
Anaerobes, streptococci, colibacilli, etc.	-	-	- / +	+++
White blood cells	-	+	++	+++
Epithelial cells	Single	+	+	++

Detection of pathogenic microorganisms in a smear in combination with moderate or severe leukocytosis (an increased number of leukocytes) is evidence of an existing disorder, one of the manifestations of which is just inflammation caused by infection. And if there is an active infection, then measures to combat it should be serious: further examination with the definition of the causative agent (sometimes a combination of microorganisms) and its sensitivity to drugs (usually potent: antibiotics, antifungal drugs, complex drugs).