Gynecological smear — Explanation and table of norms, doctors
Mandatory when visiting the gynecologist is the taking of biological material for the assessment of microflora and the epithelial cells of the vagina, the inner mucosa of the uterine body, endometrium, cervical canal. Gynecological smear, the study and deciphering of which is carried out in a laboratory environment, has high information content.
Analysis to determine hormonal levels of the reproductive system, the amount and composition of vaginal secretions, the content of bacterial flora in women, prevent inflammation, to identify developmental pathology, the presence of tumors and infections that are transmitted sexually.
Some strokes can be taken
Diseases of the female reproductive system specialized field of medicine — gynecology. Reasons for treatment the patients are many: the passage of medical examination for admission to work, pregnancy, painful or unpleasant cramping sensation in the lower abdomen, itching or burning, thrush, heavy menstruation or discharge of unknown origin.
Or common smear microscopy is carried out during routine inspection or during the period of pregnancy planning. The result is a study of cervical and urethra, vagina, virgins — the rectum.
Analysis of smears for Cytology gives an opportunity to detect HPV, pre-cancerous lesion of the epithelium, of the cervix. It is recommended to have a PAP test all women with hereditary cancers, persons aged 21 and older.
Bacteriological method of research, the cultures of women, is recommended when suspicion for an inflammatory process, a violation of microflora, which was caused by conditionally pathogenic and pathogenic microorganisms.
PCR is carried out in the form of analysis on the infections transmitted mainly through sexual contact. Gives complete information about the bacterial composition of the internal microflora. The efficiency and accuracy of the method is 98%.
Preparation for the stroke
Before appointment, the gynecologist or laboratory worker is obliged to warn a patient about how to take a smear on flora, what you can and cannot do before the procedure. Preparations for microscopic examination involves the rejection of strong antibiotics for 2 weeks before analysis, a visit to the bathroom the day before. You should try not to go to the toilet for 2 hours before analysis. Diagnosis it is better to do before and during menstruation and during the first two days after.
To increase the sensitivity of the test, the cultures on the microflora carried out in the absence of treatment with antibiotics and douching. Have to follow a special diet for 2-3 days prior to bacteriological analysis: limit foods that trigger fermentation or intestinal upset. To refrain from sexual intercourse with your partner and not to wash for 24 hours prior to data sampling.
3-5 days before the scheduled PCR diagnostics prohibited taking any antibiotic and contraceptives. 36 hours is necessary to exclude sexual contacts. Preferably the day before and on the eve of PCR tests is not a walk in shower. The material is taken during menstruation and for 1-2 days after it.
How to take a swab from women
The technique of the fence material is carried out usually in the morning hours in the Department of gynecology or directly in the laboratory. Taking vaginal secretions and areas for study is prescribed only for women who are sexually active. Girls take it more carefully from the lateral vault of the vagina to prevent damage to the hymen, and intestinal secretions.
All manipulations occur in the gynecological chair. At this time, the specialist introduces a two-way mirror, depending on the age and physiological characteristics of the patient. If the organs are not yet formed, used size XS, girls will need a mirror S. After the generic activities used tools for inspection with diameter of 25-30 mm, a size M, L.
Collection of material is carried out with a trowel or spatula, a brush, applied to a glass slide or placed in a test tube for further transfer of the obtained results in the laboratory.
Smear on flora: the transcript
Make their own conclusion about how good or bad the smear turned out to be impossible without appropriate knowledge. Using special symbolsto decipher the microscopic examination of the smear is very simple. Depending on the localization taken biological material are distinguished: the vagina "V", the cervix is a "C" and urethra "U".
Gram-positive rods, "C.+" and the lack of coccal flora. Result.»++++« — There is quite rare, often a consequence of intense antibiotic therapy. The norm: "++", "+++" sticks, cocci does not exceed the number of "++".
Gram-negative bacteria gonorrhea — "Gn", and Trichomonas vaginalis — "Trich" yeast of the genus "Candida". Correspond to the diseases like gonorrhea, trichomoniasis, and candidiasis.
The presence of key cells and E. coli, if they are listed in the composition of the microflora, suggests that the patient is present bacterial vaginosis.
Smear on flora: the normal women
All, without exception, the patients, ranging from 14 years and before menopause, there corresponds one and the same rule obtained in the laboratory microscopic examination.
Leukocytes. Protecting the body from penetrating viruses, bacteria and infections may be in sight, but must not exceed the figure of the vagina 10 and the cervix — 30, the urethra — 5.
Epithelium. A moderate amount of epithelial tissue is normal. A large number indicates possible inflammation and too low — insufficient production of the hormone estrogen.
Mucus. The slight quantity, or lack thereof. The maximum daily rate of discharge of secretions of the glands of the cervical canal — 5 ml.
Gram-positive rods, "C.+". Must contain lactobacilli and sticks Doderlein in large quantity. They are responsible for the immune response to foreign bodies. In the cervix and urethra they shouldn't be.
«Gr.-", gram-negative, anaerobic sticks are not defined.
Gonococci with the symbol "gn", Trichomonas, chlamydia, the key and abnormal cells, fungi, yeast, Candida no. If they are detected in the results, the patient is assigned additional screening for gonorrhea, trichomoniasis, chlamydiosis, bacterial vaginosis, yeast infection.
Smear on the degree of purity
To avoid complications in the period of gestation, pregnant women are recommended to determine the degree of purity of gynecological smear. In normal healthy women the vaginal microflora by 95-98% are Bacillus vaginalis or Lactobacillus sticks Doderlein. They produce lactic acid, which helps to preserve the level of acidity. Pathogenic and conditionally-pathogenic microorganisms can not survive in such conditions. But under the influence of various factors like sexual activity, menopause, menstrual cycle and decrease in immunity, indicators of the microflora can change.
- 1 the degree of purity of the vagina in normal pH is 3.8 to 4.5. Wednesday — sour. Leukocytes and epithelial cells is not more than 10.
- 2 the degree. Acidic environment: pH=4,5-5. There is a slight increase in gram-positive cocci, fungi Candida.
- 3 degree. Aktiviziruyutsya pathogens, there is mucus indicators of the epithelium exceeds the norm. Neutral pH, pH=5-7. Leukocytes more than 10. Mucus, the key cells are present, gram-negative and gram-positive organisms multiply under favorable conditions, microflora.
At last, 4 degree, the purity is low. The pH value reach to 7.5. Sticks Doderlein or non-existent, or are in single digits. Vagina filled with pathogens.
Variety composition, in addition to lactobacilli sticks Doderlein, which are an integral part of the vaginal flora of the surveyed women begin to study immediately. Planting on a specially created favorable environment the collected biological material for subsequent growth, development and reproduction takes time. To assess bacteriological crop flora through the microscope under the condition of increasing the number of representatives of micro-organisms.
- Class 0. Observed with antibiotic treatment. The pathogen is absent.
- I class. The number of bacteria does not increase or moderate growth.
- Class II. Mixed microflora. Defines up to 10 colonies of the bacteria Gardnerella vaginalis or Mobiluncus, agents gardnerellosis.
- Class III. Colonies there are about 100. Mainly in the live microflora Gardnerella and Mobiluncus. Symptoms of bacterial vaginosis.
- Class IV. Lactobacilli are absent, the immune system is weakened. The diagnosis of acquired infections — aerobic vaginitis.
The probability to detect areas of altered epithelium, papilloma virus and cancer tumors big enough after 30 years, onset of sexual activity. So gynecologists recommend PAP for Cytology or PAP test. The source material for Cytology is the cervical canal, the vaginal portion of the cervix. The correct interpretation of a PAP test depends on the presence or absence of cancer, atypical cells.
- NILM. The clinical picture, tsbo. Leukocytes and bacteria are distinguished in a small amount. First candidiasis or bacterial vaginosis. The epithelial layer was normal.
- ASC-US. Discovered atypical areas in the epithelial tissue of unknown origin. Re-analysis is carried out using6 months in search of chlamydia, dysplasia, human papillomavirus.
- LSIL. To confirm a pre-cancerous condition called atypical cells, prescribe a biopsy colposcopy. Subtle signs of changes of the epithelium.
- ASC-H. pronounced lesion of squamous epithelium. 1% of patients diagnosed with initial stage cervical cancer, the remaining 98-99% have dysplasia 2-3 degrees.
- HSIL. Associated symptoms, previous cancer of the squamous epithelium, of the cervix, is diagnosed in more than 7% of the surveyed women. 2% of cancer.
- AGC. Abnormal condition of glandular epithelium. Diagnosis: cancer of the cervix or endometrium, advanced forms of dysplasia.
- AIS. Squamous cell carcinoma, cervical cancer.
High sensitivity and reliability of the data differs by the molecular biological method PCR diagnosis. Thanks to the creation of the earlier samples isolated and copied DNA region is compared with the received biological material.
Analysis of infection using PCR allows for a short period of time to find a pathogen of the female genital organs by getting positive or negative result. Polymerase chain reaction facilitates the definition of chlamydia, Ureaplasma, yeast infection, trichomoniasis, HPV, HIV, search for the causes of severe pregnancy and hormonal disorders. The disadvantages of PCR are cases of false data when properly conducted tests, the possible mutation of the DNA of the pathogen.