Smear for flora: indications, preparation, technique

The human body is a complex system, in the proper functioning of which some microorganisms also participate. Some of them actively participate in vital and secondary processes, while others simply peacefully coexist with us for the time being. It must be said that our health is directly related to the ratio of useful and not so useful bacteria in the body. Our opportunistic "neighbors", along with pathogenic "guests" can significantly spoil the overall picture of women's and men's health, and in order to assess to what extent, doctors resort to a special diagnostic method - taking a smear and examining it. At the same time, the flora in the smear is not yet a pathology, rather its absence is alarming. It is more important to pay attention to the composition of the microflora, which gives the doctor important information about the patient's health and methods of its restoration.

What is a smear test?

Microflora testing is an important component of a gynecological examination in women. The location of a woman's reproductive organs, most of which (vagina, uterus, ovaries, appendages) are hidden inside the body, does not allow a visual assessment of their health, so doctors, when assessing a woman's health, simply cannot do without laboratory tests, the material for which is taken by means of a smear.

In men, it would seem that the genitals are visible, but an external examination does not allow us to assess the composition of the microflora and identify pests in it, if complaints of discomfort in the intimate area appear.

A smear for flora is one of the important diagnostic methods that allows obtaining biomaterial for microscopic laboratory testing from the surface of the skin and mucous membranes. Most often, this concept is understood as taking material from the surface of the vaginal mucosa. But it can also be biomaterial from open or hidden under folds of skin areas of the penis, from the pharynx and nose, or from the ear, if a person has complaints of deteriorating health.

There are several types of such examination: a general smear, a smear from the vagina in women or the urethra in men with subsequent bacterioscopy (examination under a microscope), a smear to detect and determine the type of infection (PCR analysis), a smear for cytology (Pap smear for atypical cells).

A smear for microflora with subsequent examination of the biomaterial under a microscope is one of the simplest and most accessible methods of bacterioscopic examination, helping to identify the pathogen, i.e. the cause of the patient's illness, and sometimes the people in contact with him. True, to name the identified pathogen by name, more complex, expensive and time-consuming analyses are required, but a smear examination under a microscope using staining reagents tells doctors which direction to take.

More complete information about the nature of the infection can be obtained after conducting a PCR analysis, the material for which is again the secretion of the genitals, taken during a smear. Predisposition to cancer is revealed during a cytological study based on the same biomaterial, but only a histological analysis (biopsy), which requires a piece of living tissue, can confirm oncology.

What does a smear test for flora include? This is a study of biomaterial taken from the surface of the mucous membranes for the presence of beneficial (lacto- and bifidobacteria), opportunistic (for example, coccal microflora) and pathogenic bacteria, fungi, protozoa, in which the concentration of each type of microorganism in a unit of volume is also calculated, their size and shape are assessed. Additionally, the number of red and white blood cells (erythrocytes and leukocytes) in the discharge of the mucous membranes is calculated, and the content of epithelial cells is determined. The analysis can also reveal the presence of atypical cells, which indicates a predisposition to tumor diseases.

Such a study is necessary both in the presence of an inflammatory or purulent process, and for preventive purposes, because sometimes the infection behaves so quietly that a person, already being sick, does not experience any symptoms of illness until a certain moment.

Indications for the procedure

There may be different reasons for conducting a microflora analysis, and it is important to take into account the complaints of patients and the specific features of a particular study. If we are talking about a preventive gynecological examination of women, which representatives of the fairer sex who are sexually active should undergo regularly 1-2 times a year, then a smear for microflora is taken without fail, which is a preventive measure for the development of infectious and inflammatory and venereal diseases.

There are situations when an unscheduled visit to a gynecologist is required, which also includes a smear test. Such situations include forced sexual intercourse, suspected STIs in a sexual partner, non-selectivity in sexual relations, when the risk of infectious infection increases, as well as the discovery of unusual rashes, hyperemia or plaque on the penis in a regular partner (it is better to be on the safe side).

Other indications for a general smear and bacterioscopy in women may be complaints of unpleasant symptoms, such as:

• pain in the lower abdomen, including that associated with urination, a pulling sensation,
• itching, burning in the genital and vaginal areas,
• the appearance of unusual (cheesy, yellow or green purulent) or too abundant transparent discharge, an unpleasant smell of the discharge,
• hyperemia and irritation in the intimate area, especially some time after sexual contact,
• pain during intercourse.

A serious disruption of the vaginal microflora is a common consequence of long-term use of antibiotics, so even in the absence of gynecological symptoms, it is recommended to undergo a preventive examination by a gynecologist with a mandatory smear.

Taking a smear followed by cytological examination of the biomaterial during an annual visit to a gynecologist is recommended for women:

• suffering from infertility,
• in case of menstrual cycle disorders,
• with manifestations of genital herpes or papillomavirus infection,
• in case of obesity,
• in case of taking hormonal contraceptives,
• during an active sexual life (especially when changing sexual partners),
• the day before the installation of an intrauterine device,
• if a visual examination reveals neoplastic processes in the cervix (erosion, dysplasia, compaction).

A smear test is an important step in pregnancy planning. It is prescribed to prevent all sorts of unpleasant surprises after conception. Any gynecological diseases should ideally be treated before this moment. This way, a mother can take care of the health of her future son or daughter in advance.

If necessary, such a study can be carried out even during pregnancy, since it does not involve deep penetration into the uterus, and therefore cannot be a factor that can injure the fetus. When examining pregnant women in a gynecological chair, doctors take a smear for preventive or therapeutic purposes.

In men, a smear for microflora is taken from the urethra (in some cases, sperm or prostate secretion may serve as biomaterial for research). Such research is carried out both for diagnostic and preventive purposes when visiting a urologist or a specialist in venereal diseases.

Indications for performing a smear test for diagnostic purposes may be the following:

• the appearance of unusual, and especially purulent discharge from the urethra with or without an unpleasant odor,
• discomfort in the penis area (pain, burning, itching, etc.),
• suspicion of sexually transmitted infections (both sexual partners must be examined)
• long fruitless attempts to become a father,
• casual sex (for preventive purposes).

A smear test for flora is a diagnostic method used not only in gynecology, urology or venereology. It can be used to diagnose and identify the cause of ENT diseases. A study of discharge from the pharynx, nose or ear can be prescribed to both adults and children if an infection is suspected.

This type of analysis may be prescribed:

• in acute tonsillitis (angina), suppuration of the tonsils, infectious mononucleosis,
• for inflammatory diseases of the nose (rhinitis, sinusitis) or throat (pharyngitis, laryngitis), in order to understand the nature of the pathology, i.e. to determine the type of pathogen,
• in case of chronic or frequently recurring runny nose and systematic colds (for example, frequent bronchitis),
• to study the composition of secretions from the lower respiratory tract during coughing in tuberculosis, as well as in cases of suspected pneumonia.
• for various forms of otitis, damage to hard-to-reach tissues of the hearing organ (smear from the surface of the outer ear).

For preventive purposes, i.e. without pathological symptoms, a smear test for flora is prescribed extremely rarely in ENT practice.

[ 1 ], [ 2 ], [ 3 ]

Preparation

The quality of the biomaterial being examined, and therefore the reliability of the analysis results, largely depend on proper preparation for the study. Most analyses are subject to certain requirements, including rules for preparing for the collection of material, which must be followed by both doctors and patients. The accuracy and informativeness of the information received by the doctor after the analysis to help in making a diagnosis and prescribing adequate treatment depend on this.

At the same time, the requirements set by different doctors may differ slightly. So, the gynecologist will first of all tell the patient what not to do before the analysis. It is believed that the reliability of the analysis can be negatively affected by sexual intercourse, douching, the use of lubricants, some contraceptives, vaginal forms of various drugs, taking a bath. You will have to give up all this the day before the analysis, and it is better to refrain from sexual intercourse for a couple of days before the study.

On the eve of the analysis, you can perform hygienic procedures in the intimate area, but without using detergents. In this case, you can only wash the external genitals and perineum.

In the life of women of reproductive age, an event occurs every month when the uterus is cleansed with the release of blood into the vaginal cavity (menstruation). Since a smear for flora is taken from the vaginal mucosa and cervical canal, it is not recommended to carry it out during menstruation (except for acute indications and with a note on the phase of the menstrual cycle). The presence of blood in the smear somewhat distorts the overall picture and affects the reliability of the analysis results.

On the last day of menstruation or during the first days after menstruation, a smear for flora will have a certain value, but there will be insufficient information about the epithelial component of the smear (exfoliated cells come out with menstrual blood), which is necessary for diagnosing dysplastic and tumor processes. And such a study will not provide accurate data on the balance of vaginal microflora.

The optimal time for taking a smear for microflora for preventive purposes, in case of inflammation or suspected infection is considered to be 7-10 days after menstruation. It is during this period that the reliability of the microscopic examination information will be maximum. If there are no acute indications and special urgency, doctors suggest postponing the analysis to a more suitable day.

It is easier for men in this regard. They can have the test done any day when they visit a urologist or venereologist. However, it is still worth adhering to some restrictions on the eve of the test.

Abstaining from sexual intercourse a couple of days before the study is common for both men and women. Men, like women, are advised to carry out hygiene of intimate areas without using detergents (especially with an antibacterial effect) the day before the collection of biomaterial. Only neutral soap is allowed.

Representatives of the stronger sex will have to be patient, not going to the toilet for 2-3 hours before the analysis (this is also recommended for women, but for obvious reasons only a few adhere to this rule). Since the urethra of men is also the penis, the act of urination can distort the overall picture of the microflora.

If a smear test for flora is prescribed by an otolaryngologist, therapist or pediatrician, in this case there are specific rules for preparation that reduce the likelihood of a false result.

Patients are advised not to eat or drink anything for 2 hours before the biomaterial is collected. It is clear that hygienic and medical procedures such as brushing teeth, gargling or treating the throat with antiseptics, using mouthwashes and mouth fresheners with an antibacterial effect, using anti-inflammatory ointments and sprays in the outer ear area, etc. are prohibited.

Since a smear test for microflora is designed to identify various pathogens, any previously conducted treatment procedures aimed at combating them and the inflammatory process should be postponed in time. Thus, you should stop taking various forms of antibiotics and antifungal drugs a week before taking the test. You should also notify your doctor about taking other medications before the biomaterial is collected.

Technique flora smear

As we have already noted, taking a biomaterial for microflora testing is an easy procedure to perform, although it does bring some discomfort to the patient. In women, a smear for flora is taken during a gynecological examination on a chair, which allows taking biomaterial not only from the cover of the external genitalia, but also from the surface of the vagina, including the entrance to the cervical canal of the uterus. At the same time, most women experience mild discomfort, which intensifies if there is severe inflammation and irritation of the mucous membrane.

Ideally, the gynecologist should take 3 types of smears from different parts of the woman’s genitourinary system:

• opening of the urethra (cystitis is one of the infectious and inflammatory diseases that has symptoms similar to gynecological pathologies),
• mucous membrane of the vaginal walls,
• the outer surface of the cervical canal in the cervix (a smear can show both the presence of infection and the development of dysplastic processes that require further examination - biopsy).

There is a special tool for collecting biomaterial - a medical gynecological spatula, which helps to obtain a sufficient amount of mucous secretion without damaging it. The device for taking a smear is a flat plastic spatula the size of an ear stick.

If it is necessary to take a smear also from the cervical canal, doctors prefer a double-sided Volkmann spoon or a cervical (gynecological) brush.

Recently, disposable plastic instruments have been used, which are not inferior in strength to reusable metal ones. Such instruments are included in many individual gynecological kits.

Using a medical spatula (Volkman spoon, cervical brush or sterile cotton swab), the biomaterial is placed on a clean glass slide and spread over it. The doctor makes a mark on the slide indicating the location from which the smear was taken:

• the letter C usually denotes the cervix,
• English U speaks of urethra
• The letter V is assigned to a vaginal smear.

This is very important for determining the localization of the infection and the extent of the pathological process.

A smear test for flora during pregnancy is considered mandatory due to the safety and high diagnostic value of the procedure. It is carried out at least 2 times. Such a study should be carried out when the expectant mother is registered at the antenatal clinic and approximately at the 30th week of pregnancy. Any discomfort in the genital area and lower abdomen during pregnancy is also a good reason to visit a gynecologist and prescribe a smear test for flora, because it is very important that a possible pathology is detected as early as possible, before the infection can penetrate the placenta and affect the development of the fetus.

The technique for performing a smear during pregnancy is practically no different from that during other periods of a woman’s life, only the doctor is especially careful and cautious, because he is responsible for the health of two people at once.

A smear for microflora in men can be taken from the urethra, and in the presence of skin symptoms on the penis and from its surface (using a medical spatula). The device for analyzing the secretion of the urethra is a special disposable probe with a brush on the end, which is inserted into the opening of the urethra to a depth of 4-5 cm. The contents of the urethra are extracted by means of rotational movements, which somewhat injures the walls of the urethra and can be quite painful.

Today, a smear for flora in men can be taken in a different way, which is considered less painful. We are talking about sowing, for which special disposable kits are produced. They include a tool for insertion into the urethra with a cotton swab on the end (it can also be used to take a smear from the surface of the penis) and a medium where the biomaterial is placed after the smear is taken (placed in a flask).

To take a swab from the throat, nose or ear, a special disposable spatula is used, which is different from the otolaryngological spatula used for examining the throat.

How long does it take to do a smear test?

The procedure itself takes a minimum of time. A gynecological (as part of an examination on a gynecological chair) or otolaryngological smear will take no more than 1-2 minutes. A smear from the urethra in men may require 2-3 minutes. But the duration of the analysis of the obtained biomaterial will depend on the type of study (the result of microscopic studies is usually ready within 1 working day, and PCR analysis in different laboratories takes different amounts of time).

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

Conclusion

Our readers probably have no doubts about the necessity of such a simple but highly informative procedure as a smear from the genital or ENT organs. After all, a simple and low-trauma procedure after examining the obtained biomaterial allows the doctor to make an accurate diagnosis and largely determines the choice of drugs for the treatment of infectious pathologies.

It is easy to imagine how much the incidence of disease among women would decrease if all of them consciously and regularly underwent examination by a gynecologist, which includes taking a smear. The fact is that the flora found in the smear can tell the doctor much more than the patient's complaints of malaise. And this is not surprising, because the overwhelming majority of infectious diseases have a latent period, when the infection is already in the process of development, but there are no noticeable or visible symptoms yet.

And even when symptoms appear, not all women pay attention to them. Usually, we do not rush to the gynecologist, trying to find an explanation for our ailment on the Internet or in stories of other people who “also had something similar, but it went away successfully” or were cured with certain drugs, methods and traditional medicine. It is this attitude to the health problem that often becomes the cause of advanced diseases that are difficult to treat.

The situation is identical with men, many of whom consider it beneath their dignity to even open their mouths wide during a throat swab, let alone tell a urologist about their problems, much less put them on display. Well, that's the nature of men, which can only be overcome by an effort of will. And to do this, you need to realize the extreme need to take care of your health and feel responsible for your loved ones. In the case of STIs, it would be more honest to tell everything frankly and solve the problem together than to hide your infidelities and thereby cause significant harm to the health of someone dear to you.

In fact, two minutes of "shame and suffering", which means taking a smear from the intimate area, are not worth the lost health, which is more important than anything on earth. Whatever flora is found in the smear, the information obtained is of great diagnostic value, because it helps to maintain and, if necessary, restore our health.

[ 10 ], [ 11 ], [ 12 ]