What examines a smear in women. How is it carried out and what does a microflora smear test show?

Leukocytes in a smear in the vast majority of cases are a sign of an inflammatory process in the organs of the urogenital tract, both female and male. However, a rare man, especially at a young age, can “boast” that he had a smear taken if everything is in order with the genitourinary system. For men, smears do not belong to mandatory tests during medical examinations. Another thing is women. Probably, those do not exist, which, at least once a year, are not subjected to such manipulations. And this is in the absence of pathology, but if there are problems, then smears are taken as needed.

Norm and pathology

The material from the male urethra is normally not abundant. Solitary leukocytes, transitional epithelium in a smear, single rods - that's all that a healthy man can provide us. The appearance of a large number of leukocytes in a smear of the stronger sex, as a rule, is accompanied by the presence of the culprits of inflammation(, yeast-like fungi of the genus, etc.), which is treated, and then the analysis is taken again to ensure the success of the measures taken.

As for women, an increased number of leukocytes is observed before menstruation and is considered an absolutely natural phenomenon. In addition, the elevated content itself (the norm is up to 30 cells in the field of view) does not apply to reliable indicators, the absence of morphological signs of these cells is considered evidence of the norm of leukocytes. They are “calm”, not destroyed (the nuclei are preserved), there are no signs of phagocytosis. In addition, sometimes the reason for the error of the diagnostician may be incorrectly taken material. An example is a “thick” smear, which is practically not visible due to the fact that the entire field is dotted with clusters of overlapping cells (including leukocytes). Without risking a mistake, in such cases, the woman is offered to take the test again.

Table: Norms for smear results for women

V - material from the vagina, C - cervical canal (cervix), U - urethra

Flora and cytology - what is their difference?

If in men the analysis is taken only from the urethra, then in women there are more objects of study: urethra, vagina, cervix, cervical canal. True, sometimes they take an aspirate from the uterine cavity and also make smears, but this is considered a biopsy material that is viewed by a cytologist. He also draws a conclusion. Aspirates are not taken during routine examinations, this analysis is used exclusively for diagnostic purposes to detect cancerous and precancerous diseases of the main reproductive organ in women. In addition, if the aspirate is filled with formalin, and then applied to the slides and painted, a histological preparation will be obtained, which is considered the last resort in the diagnosis of malignant neoplasms.

Probably, many have heard the expressions: “a smear for flora”, “a smear for cytology”. What does all of this mean? How are they similar and how are they different?

The fact is that in a smear on the flora at high magnification with immersion, the doctor can count the cells, detect trichomonas, yeast, diplococci, gardnerella and other microorganisms, representing a rich biocenosis of the female genital area. But he will not be able to determine the morphological changes in the epithelium, since these are different areas of laboratory diagnostics, where cytology occupies a separate niche. The study of the cellular composition of some material requires, in addition to certain knowledge, also special training. The study of pathological changes in the cell and nucleus theoretically gives very little, here, as they say, a trained eye is needed.

The doctor is engaged in deciphering the analysis in both cases (flora and cytology), we only have to slightly familiarize ourselves with some concepts so that when faced with a similar problem, we do not get scared and do not panic.

Cytological examination

The tasks and functions of cytology are much broader, and therefore its possibilities are wider. The doctor examining the material focuses on the state of epithelial cells in order to identify pathological processes (inflammation, dysplasia, malignant neoplasms) and at the same time notes the flora. Most often, the vaginal portion of the cervix, represented by stratified (four-layer) squamous epithelium (SPE) and the cervical canal, is subject to research. With a correctly taken smear from the cervical canal in the cytological preparation, at the norm, the prismatic (cylindrical) epithelium, single leukocytes and depleted microflora, which could come from the underlying sections (from the vagina, for example), are clearly visible.

It should be noted that the cytological preparation is more informative, since the method of staining (according to Romanovsky-Giemsa, Pappenheim or Papanicolaou) gives a clearer picture. Cells are viewed first at low magnification to assess the general state of the drug, and then at high magnification (with immersion) in order to consider not only the epithelium itself, but also changes in the nucleus characteristic of a particular disease. In a word, the cytologist sees the flora, inflammation, and in most cases its cause and changes that this inflammatory process entailed. As well as indicative signs of infections that present particular difficulties in diagnosis, precancerous and neoplastic conditions of the epithelium.

Video: about a smear for oncocytology

Indirect signs of some STIs in cytology

As for the smear for STIs, it is desirable to examine it as a cytological preparation. A smear taken on the flora and stained with methylene blue is the most important, affordable and cheap, and therefore the most common diagnostic method in gynecology. However, unfortunately, it does not provide the necessary completeness of the picture for the diagnostic search for STDs and their consequences.

In addition to all possible inhabitants that, when infected or disturbed, are visible in a smear on the flora (Trichomonas, yeast, leptothrix), indirect signs of the presence of microorganisms can be found in the test material (cytology), which are very problematic to identify using microscopic methods:

• The appearance of giant multinucleated MPE cells, sometimes of a rather bizarre shape, often with signs of parakeratosis and hyperkeratosis (keratinization), indicates a possible lesion;
• Cells in the form of an "owl's eye" with coarse-grained cytoplasm are characteristic of;
• When it is possible to detect koilocytic atypia (MPE cells with large nuclei and an area of ​​enlightenment around the nucleus);
• Indicative are the bodies of Provachek in the cells of metaplastic epithelium, which are characteristic of and play an important role in screening studies.

Of course, it is impossible to diagnose a herpetic, cytomegalovirus or papillomavirus infection with a cytological analysis, but it can be assumed, and this is already the basis for a further, more in-depth examination in a specific direction (, etc.). Thus, cytology allows you to narrow the range of diagnostic search, avoid unnecessary tests, save time, and promptly start treatment.

How to prepare for the analysis?

Since the simplest and most accessible method for detecting inflammatory processes in the urogenital tract, both in men and women, is a smear on the flora, it is necessary to pay more attention to it and teach the reader to understand a little about the entries on the form.

However, before making a visit to the doctor, Patients should know some simple rules:

1. A couple of days before the test, it is necessary to exclude not only sexual contacts (sometimes spermatozoa can be seen in a female smear), but also all sorts of interventions such as douching, the use of local medications (suppositories, creams, tablets);
2. You should not go for such a study during menstruation, because menstrual blood will interfere with viewing the drug, where the doctor will see it mainly;
3. On the day of the examination, you need to calculate the time so that you urinate for the last time in 2-3 hours, since urine can wash out all the “information”;
4. 7-10 days before the analysis, stop taking pharmaceuticals, especially antibacterial ones, or take a smear only a week after the end of treatment;
5. Another rule that women often ignore is not to use intimate hygiene products. Of course, it is very difficult to refrain from such procedures in general, as experts recommend, but at least you can limit yourself to clean warm water. Men, on the other hand, carry out the last toilet of the external genital organs in the evening on the eve of visiting the doctor.

After following these tips, a person goes to an appointment, where they will take a smear, paint and look under a microscope. The doctor will take care of the decoding, and the patient will receive a conclusion in his hands, and he will probably be interested to know what all these numbers and words mean.

Video: preparing for a smear

What can be seen in a male urethral smear?

Probably, the reader has guessed that the analysis of men is unlikely to leave pleasant memories, because the object of study is not so accessible to them, so there will really be unpleasant sensations that may not leave the person for several more hours. Sometimes, in order to avoid this, the doctor prescribes a prostate massage to the patient, which is carried out a few days before the procedure per rectum, that is, through the rectum.

However, if the burning sensation and soreness in the penis continues to remind of itself for several days, and these phenomena have also been added similar to, a trip to the doctor is inevitable. But if everything went well, then maybe men will be reassured by the fact that everything looks much simpler in their smear taken from the urethra, unless, of course, normal analysis:

• The norm of leukocytes is up to 5 cells in the field of view;
• The flora is made up of single sticks;
• The general background dilutes the urethral epithelium (mostly transitional) - approximately 5-7 (up to 10) cells;
• A small amount of mucus, which does not play any role;
• Sometimes a smear may contain opportunistic flora in single specimens (streptococci, staphylococci, enterococci), however, in order to differentiate it, it is necessary to stain the smear according to Gram.

In the case of an inflammatory process, the smear changes:

1. A large number of leukocytes appear in the smear, sometimes not countable;
2. Coccal or cocco-bacillary flora displaces rod;
3. The preparation contains microbes that caused inflammation (trichomonas, gonococci, yeast, etc.);
4. It is hardly possible to see microorganisms such as chlamydia, urea- and mycoplasmas under a microscope, just like distinguishing pathogenic diplococci that cause gonorrhea from enterococci lying in pairs or a chain of Enterococcus faecalis (enterococci too) from streptococci, therefore, in such cases, to clarify the species pathogen, the study is supplemented by a cultural method or the almost universal and popular nowadays PCR (polymerase chain reaction);
5. With rare exceptions, in a man's smear, you can find E. coli (a flagrant violation of hygiene rules!), Beneficial in the intestines, but causing cystitis, getting into the urethra of a man. For its differentiation, additional laboratory research methods are also needed.

They do the same with female smears, since the found diplococci may not be Neisseria at all and do not cause gonorrhea. By the way, E. coli (Escherichia coli), enterococcus (Enterococcus faecalis), staphylococci with streptococci and other microorganisms in female smears are much more common, due to the structure of the female genital organs.

Ecosystem of the female urogenital tract

Leukocytes in a smear taken in gynecology, even for flora, even for cytology, are not the only cells present in the preparation. In addition, they act only as a consequence or reaction to events occurring in the ecosystem (hormonal fluctuations, inflammation). For example, their increase in different phases of the cycle is due to hormonal influence, therefore, when taking material, the date of the last menstruation is indicated in the referral form.

The diagnostic criterion of the inflammatory process is considered not only a large amount of Le, "escaping" to the place of "military operations", but also the state of their nuclei. When leukocytes react, they try to absorb the “enemy”, phagocytize, but they themselves begin to break down. Destroyed cells are called neutrophilic leukocytes, however, this phenomenon is not indicated in the decoding of the analysis. A large number of neutrophilic leukocytes, together with abundant cocco-bacillary or coccal flora, serves as the basis for confirming the presence of an inflammatory process.

The ecosystem of the female genital organs includes microorganisms that occupy certain niches, which are: the epithelium of the vagina, cervix, cervical canal, rich in endocervical glands. These anatomical formations provide conditions for the vital activity of certain microorganisms. Some of the inhabitants are mandatory (obligate), while others come from outside due to certain circumstances and cause various inflammatory reactions of the epithelium.

In addition, the balance in the ecosystem can be disturbed by various factors that negatively affect the woman's body (both internal and external), which lead to the fact that microbes living in small numbers begin to displace natural inhabitants representing rod flora and occupy the dominant position. An example of this is the colonization of the vaginal environment with gardnerella, which for a number of reasons displaces lactobacilli (Doderlein sticks). The result of such a "war" is widely known.

The norm in a gynecological smear

The microscopic creatures that live in the genital tract of a woman are diverse, but the norms still exist, although sometimes it is very difficult to determine their boundaries, but we will still try to do it. Thus, in a smear taken in gynecology, you can find:

• Leukocytes, the norm of which in the urethra is up to 10 cells per field of view, in the cervix and its canal - up to 30 cells. During pregnancy, these indicators change upwards;
• The type of epithelium in the smear depends on the place where the material was taken: the urethra, the neck, the vagina are lined with stratified squamous epithelium (SSE), which we will get in the preparation. A smear from the cervical canal will be represented by a cylindrical (prismatic) epithelium. The number of cells changes in different phases of the cycle; in general, it is generally accepted that, at the norm, their content should not exceed 10 units. However, this is all very arbitrary, since accurate diagnosis should be considered morphological changes in cellular structures(nucleus, cytoplasm, the presence of "naked nuclei"), that is, to conduct a cytological analysis;
• Mucus in the preparation is considered an obligatory, but moderate, component, because the glands of the cervical canal and vagina secrete it. The mucus looks interesting in the ovulatory phase of the menstrual cycle, it crystallizes and forms patterns similar to the leaves of a plant, which are called the "fern symptom" (cytology);
• A normal smear, as a rule, is represented by rod flora (lactobacilli) and single cocci.

Conditionally pathogenic flora is not always the norm

In addition to lactobacilli - the main representatives of the normal microflora of the genital tract, which are assigned important function"self-purification of the vaginal environment", in a smear, other, conditionally pathogenic, microorganisms can be found in small quantities:

All these representatives of the microflora can live without disturbing anyone, or cause inflammation under certain conditions. By the way, even lactobacilli in excess and in abundant bacterial flora can provoke an inflammatory process - lactobacillus, manifested by itching, burning, discharge. The disease, of course, is not fatal, but very painful.

Pathogenic "guests"

The presence of pathogenic microorganisms, transmitted mainly through sexual contact, almost always causes trouble. Local inflammation caused by the pathogen can spread to other organs and systems and (often) become chronic if not treated in time.

This phenomenon is especially dangerous during pregnancy, since many pathogens can have a very negative effect on the fetus, so a bad smear during pregnancy is a guide to action, moreover, immediate. What microorganisms can threaten the human reproductive system through sexual transmission? Probably, we will not surprise anyone by naming them, but once again it still does not hurt to recall the danger posed by microscopic creatures.

gonococcus - the causative agent of gonorrhea

Thus, the pathogenic microflora of the genital tract includes:

What is the degree of purity?

A smear for the degree of purity of the vagina is taken as a regular smear for the flora, but is evaluated somewhat differently. In gynecology, the IV degree of purity is distinguished:

I degree- a rather rare phenomenon, the smear is clean, only rod flora, single leukocytes and squamous epithelial cells in optimal quantities;

II degree- among the sticks, single cocci can “slip” or other non-pathogenic microorganisms can also be mixed in single copies, this degree is the most common among gynecologically healthy women;

table: standards for assessing the cleanliness of the vagina

III degree- it is characterized by conditionally pathogenic flora and yeast-like fungi, which tend to actively reproduce. This may indicate the development of an inflammatory reaction to the presence of an excessive number of opportunistic microorganisms. This analysis involves an additional examination of the woman;

IV degree- signs of an obvious inflammatory process: abundant coccal or cocco-bacillary (mixed) flora, the presence of Trichomonas, gonococci or other pathogenic microorganisms is possible. In such cases, additional laboratory tests (bacteriological, PCR, etc.) are prescribed to search for the pathogen and further treatment.

A smear on the flora, although it is considered a simple method, but has great potential. The first step in laboratory diagnostics diseases of the urogenital tract, at times, immediately solves the problem and allows you to immediately begin therapeutic measures, the quality of which will subsequently be controlled by the smear itself, therefore it is not recommended to avoid such an accessible procedure. It does not require a lot of expenses, and the answer will not have to wait long.

A smear on flora is the simplest, but informative method for examining women's health. It allows you to identify many pathological processes. Before visiting a gynecologist, it is advisable to find out what a smear shows on the flora in women.

The vagina has its own flora, which is inhabited by beneficial microorganisms. With the development of pathogenic microflora, unpleasant sensations arise, for example:

• lower abdominal pain;
• change in volume, color or consistency of secretions;
• itching or burning in the vagina;
• unpleasant odor from the genitals.

A gynecological smear shows the state of the microflora, as it is populated by microorganisms. With it, you can judge inflammation, hormonal disorders and infectious diseases. It allows you to identify pathogens of chlamydia, gonorrhea, candidiasis and other diseases that are sexually transmitted.

Important. In order to prevent gynecological diseases, you need to take a smear every 6 months.

Degrees of purity of the vagina

By purity, one can judge the microflora, whether it is normal or pathogenic. In total, 4 degrees are distinguished, but only the first two are the norm.

Characteristic:

• I degree. She is rare. The medium is acidic, pH=4-4.5. Leukocytes, Dederlein's sticks and other indicators are within the normal range.
• II degree. The acidity of the vagina decreases, the pH increases to 5. This indicates that the flora is inhabited by a small number of pathogenic microorganisms. There is no inflammatory process, so leukocytes are not exceeded. The infection is at the initial stage of development, so Candida fungi and cocci may appear.
• III degree. The growth of pathogenic microflora is detected, but the number of lactobacilli is significantly reduced. The vaginal environment becomes alkaline, pH = 5-7. Epithelial cells indicate inflammation.
• IV degree. The pH changes, it is 7-8. White blood cells, mucus and other inclusions are much higher than normal. Lactobacilli are absent, the flora is pathogenic.

III and IV degrees need treatment.

Norms of smear results on flora

According to the data in the table, the smear is decoded into flora. The results obtained are compared with normal values. If at least one parameter does not correspond to the norm, then treatment is necessary.

Deciphering the results

To indicate the place where the smear is taken, the doctor uses the following Latin letters:

• V - contents from the vagina;
• C - from the cervix;
• U - from the urethra.

The letters also indicate the inclusions that were found, for example, leukocytes (L), squamous epithelium (Ep), gonococci (gn), Trichomonas (trich).

Epithelial cells should be present, if not, then this is a sign of atrophic processes in the uterus. With inflammation, the content of mucus and leukocytes increases.

An excess of beneficial microorganisms can indicate pregnancy, but a decrease in them is a bad sign. This happens with an infectious disease at an early stage.

Key cells appear with bacterial vaginosis, yeast fungi - with thrush. An increased content of cocci indicates infections of the reproductive system.

Coccobacillary flora in a smear

In conclusion, you can see the word "cocci". They can be present even in a healthy woman, but in this case their number is very small.

If the number of cocci increases, then coccobacillary flora develops in the smear. This indicates severe inflammation, the woman is diagnosed with nonspecific colpitis.

It is important to consider whether cocci are Gram-positive or Gram-negative. This depends on the treatment. Gram (+) cocci are streptococci or staphylococci. They are less resistant to antibiotics. Gram (-) cocci are more dangerous. They cause gonorrhea, are more resistant to antibiotic treatment.

What are Dederlein sticks?

If the conclusion says "rod flora", then this is good. Dederlein sticks inhabit the microflora of the vagina, so their number should be large. They include lactobacilli and gram-positive rods.

Dederlein sticks maintain a high acidity of the vagina, inhibit the growth of pathogenic microflora and provide a high degree of purity.

Leptothrix in a smear

This is a bacterium that indicates a change in the composition of the microflora. It is not sexually transmitted, but appears against the background of other infections, such as chlamydia or Trichomonas. Also, its appearance may be associated with thrush or bacterial vaginosis.

Important. If a leptothrix is ​​detected, an additional examination will be required, for example, PCR diagnostics.

Norm and pathology during pregnancy

For the birth of a healthy child, the microflora must be brought back to normal at the planning stage. In order to prevent gynecological diseases, a pregnant woman should take a smear 3 times: when registering, at 30 and 38 weeks.

Important. If the nature of the discharge changes, it is urgent to contact a gynecologist.

The composition of the microflora of a pregnant woman differs from the normal indicators of a healthy woman. The differences are:

• The number of gram-positive rods increases tenfold, and the acidity of the vagina increases accordingly. Such changes are needed to protect against infections. Lactobacilli inhibit the growth of pathogenic microorganisms that die in an acidic environment. The norm of gram-positive bacteria in the vagina is up to 20, in the urethra - up to 5, in the cervix - no more than 30.
• The number of epithelial cells increases. They are food for lactobacilli.

The remaining indicators do not differ from the norm. The smear should be free of yeast, cocci, Trichomonas and other pathogenic infections. They cause inflammation, can cause infection of the fetus and miscarriage. That is why before pregnancy it is important to normalize the state of the microflora and cure all diseases.

How to prepare for the analysis?

The accuracy of the analysis depends on the preparation for the study, therefore, 2-3 days before visiting the gynecologist, it is necessary to refuse sexual intercourse, do not take a bath, do not use suppositories and creams, do not douche, do not take pills.

On the day of the test, you need to take a shower. An important component of the preparation is intimate hygiene. Do not use soap, shower gel or other skin cleansing products when washing, otherwise the result may be false. 2-3 hours before lying down on the gynecological chair, it is not advisable to urinate.

Vaginal microflora (vaginal flora) are microorganisms that inhabit the vagina. They are part of the general human flora. The number and type determines the woman's health status. Normally, in a smear for microflora, bacteria of the genus Lactobacilli (lactobacilli), which protect against pathogenic microorganisms, should prevail.
Lactobacilli produce lactic acid, which is supposed to prevent the development of pathogenic bacteria (Staphylococcus aureus, Escherichia coli, etc.), but a small amount in the results of their analyzes is acceptable. They also produce hydrogen peroxide (H 2 O 2 ), which has a broad antimicrobial spectrum of action, and various bacteriocins, which also kill other bacteria, but have a more narrowly targeted effect.

The normal vaginal microflora may differ in some ethical groups. Several studies have shown that a significant proportion (7-33%) of healthy women (especially blacks and Hispanics) lack significant amounts of lactobacilli. Their role is played by lactic acid bacteria from other genera, which are also capable of secreting lactic acid. Therefore, it is assumed that when setting the norm in a smear in women, the emphasis should be on the pH of the vaginal environment, and not just on the presence of lactic acid.

During the examination of a woman, a gynecologist takes a biological sample from the genitals in order to study the microflora and determine the degree of purity. The fence is carried out from the walls of the vagina, cervical canal and urethra. A diagnostic procedure is necessary to determine the composition of the microflora in order to exclude the inflammatory process.

Biological material is taken during a routine examination, as well as for complaints, such as pain above the pubis, itching and burning of the genital organs, as well as discharge indicating an inflammatory process.

When should a woman take a smear for flora?

A woman is recommended to take a smear on the flora at each visit to the gynecologist, in addition to the general diagnostic and preventive purpose, it is possible to use this method to identify those diseases that are diagnosed much earlier than symptoms appear.

Indications for the delivery of a smear are:

• Discharge from the genital tract, which may not always be pathological in nature, but simply be plentiful or accompanied by an unpleasant odor.
• Itching in the vagina or perineum, as well as pain or discomfort.
• Maceration of the skin.
• The sampling of material is necessary for preventive purposes annually.
• Before the start of antibacterial therapy from the female genital organs, as well as after treatment in order to control the assessment.
• In order to control the state of the microflora before surgical interventions, both in the area of ​​​​the external genital organs and internal ones.
• This is necessary to prevent infection and the development of complications.
• Microflora control during pregnancy. In this case, the control is carried out three times in the first weeks of pregnancy, before going on maternity leave, as well as at 36 weeks.
• This smear is screening when visiting a gynecologist, should be taken after each examination.

Each specialist performing the reception can take the material.

How to prepare?

In order to obtain reliable results of the analysis, it is required:

• During the day before the manipulation, do not douche, both with medicinal and herbal remedies, and with ordinary water.
• Avoid sexual contact especially without protection. In this case, fragments of seminal fluid may be found, which makes it difficult to make a diagnosis.
• Do not apply any medicines during the week, especially from the antibacterial and antifungal groups. This applies to both local and systemic forms.
• Any vaginal forms of funds are cancelled. It is forbidden to cancel only vital drugs.
• Do not take material during menstruation, since a large number of erythrocytes enter the obtained material, which violates the clinical picture of the process.
• Do not conduct an ultrasound examination using a vaginal probe no earlier than one day before taking a smear. This explains the ingress of a polymer gel into the biological material, which replaces the cellular composition of the smear.

How is a smear taken?

The optimal time for sampling is the middle of the menstrual cycle:

• Normally, a smear for microflora in a woman is taken from several sites at once. First of all, this is the posterior vault, the place where the maximum accumulation of microbes occurs. The urethra is the area where the fence is made in order to clarify the presence of pathogens that are tropic for this area.
• The next site is the cervical canal, this is the anatomical region that is the most vulnerable and dangerous in terms of the development of the inflammatory process.
• The material is taken with a special spatula or a Volkmann spoon.
• Do not damage the walls of the mucous membrane and, the movements should be soft, slightly scraping.
• After receiving the right amount its contents are applied to a glass slide, evenly distributing over the surface, so that no thickening areas are created.
• The slides are then dried at room temperature. and sent to the laboratory for further diagnosis.
• Already in it, special reagents are applied for further detection of microorganisms and examination under a microscope.

Analysis cost

A smear for flora is made in any budget institution absolutely free, since this method is one of the screening and mandatory. In addition, this is the minimum examination of a woman for preventive purposes.

In private clinics, the cost of such an analysis can be about 200-300 rubles. Not always a smear will be free only in the antenatal clinic, it can be done free of charge.

How to quickly recover from an infection?

Restoration and preservation of a sufficient amount of beneficial intestinal normal flora - lacto- and bifidobacteria, helps protect the intestinal mucosa from the penetration of pathogenic bacteria and their toxins into the blood and lymph, eliminate toxins, create an environment in which pathogenic microorganisms cannot continue their vital activity and are excreted from the human body . It is important that the waste products of beneficial bacteria help the immune system to remain active in the fight against harmful bacteria.

Synbiotic biocomplex Normoflorina - containing live active lacto- and bifidobacteria and their metabolites with anti-inflammatory, antiseptic, immunogenic and nourishing action on mucous membranes has established itself for many years as an active helper and fighter against pathogenic bacteria for babies and adults, pregnant women and patients with various diseases . Quite quickly, when using Normoflorins, intoxication is removed and intestinal function and general well-being are restored.

Recommended: start taking Normoflorins as early as possible in age dosages - L - 10-15 minutes before meals in the morning (+ lunch for constipation), D - lunch or evening 20 minutes before meals, B - at night or in microclysters. The duration of admission is 3-4 weeks, until the bowel function is fully restored and overall well-being improves. It is advisable to take sorbents on an empty stomach for 10-14 days - to remove toxins - zosterol or pecto, they reduce putrefactive, fermentation processes, increased gas formation, improve bowel function.

It is important to consolidate the effect of restoring microflora, improve the functioning of the pancreas, liver, intestines, immunity - for this it is good to use functional nutrition - Harmony of Life - for a month. It also contains live useful lacto- and bifidobacteria, their metabolites and pectin. Delicious, healthy and effective!

What is the difference between a smear for flora and bakposevom?

Many women are interested in the question about the differences between bacterial culture and a smear on the flora, whether they are the same analysis, and whether there is a difference between them.
Smear on flora - This is the examination of the contents under a microscope. To do this, the material is taken, after which it is fixed with special dyes and substances, such as ethyl alcohol. Microorganisms turn out to be dead in this way, and only those that fall into the field of view are counted. In this case, you can see only leukocytes, erythrocytes, the qualitative composition of the microflora, as well as the presence of specific pathogens.

Bacterial culture - This is a type of laboratory study in which the growth of microorganisms is determined, as well as the clarification of sensitivity to antibacterial agents. To do this, the material obtained from the woman is placed on a special nutrient medium, not allowing it to dry out, as well as with the presence of nutrient material for the possible nutrition of bacteria.

The method is not common, as it is considered quite expensive. At the same time, its efficiency is quite high, this is due to the fact that in some cases you can not notice a small amount of bacteria, and with their growth, the formed colonies are easily determined.

In addition, it helps to choose the most appropriate treatment. This is especially important in the presence of a recurrent process, as well as the definition of a specific pathogen.

Why is antibiotic susceptibility done in a smear test?

Sensitivity to antibiotics or antibiogram– determination of the sensitivity of bacteria to antibiotics. The study is carried out simultaneously with sowing a smear if pathogenic bacteria that cause inflammation or genital infections are found in the vagina.

There are a large number of antibiotics, but not all of them are equally effective against different groups of bacteria (antibiotics do not affect viruses). It happens that after a course of antibiotics the patient did not recover or the disease returned after a few days/weeks. This happened because antibiotics were prescribed for treatment, which had little effect on the causative agent of the disease. In order for the treatment to be as effective as possible, it is necessary to determine which antibiotics:

• completely destroy the bacterium - the causative agent of the disease;
• stop the growth of the pathogen;
• do not affect the activity of this bacterium.

Based on the study, a antibiogram. This is a list of antibiotics to which bacteria are sensitive.

How is antibiotic susceptibility testing done?

After the bacteria that caused the disease have been identified, they are distributed into several test tubes with nutrient media. A specific antibiotic is added to each tube. The test tubes are placed in a thermostat, where optimal conditions are created for their reproduction.

After cultivation (about 7 days) analyze the growth of bacteria in test tubes. Where bacteria are sensitive to antibiotics, colonies do not form. This drug is optimal for the treatment of the patient. In a test tube where drugs are added to which antibiotics are insensitive, the growth of bacteria is the most intensive. Such drugs cannot be used to treat this disease.

The degree of purity of the vagina

According to the results of a smear on the flora, its condition is assessed. The main indicators in this case are Dalerlein sticks, leukocytes, epithelial cells, as well as other representatives.

Conventionally, the state of the environment is usually divided into 4 degrees:

• 1 degree means the complete health of a woman from the microflora. It is represented only by obligate microorganisms, such as Daderlein sticks and lactobacilli. It is they who contribute to the acidification of the environment, which prevents the reproduction of other flora. In this case, leukocytes, microbes, as well as erythrocytes and pathogenic microorganisms will not be observed.
• At 2nd degree, the most frequent group in women who are sexually active, the presence of not only obligate microorganisms, such as lactobacilli, but also single cocci is noted. It is not excluded that leukocytes may also appear, in an amount of not more than 10 pieces. Epithelial cells should not exceed 5. This cannot be considered a pathology, since lactobacilli cope with their function, there is no inflammatory process, but this flora can come from contact with a sexual partner. Cocci are normally found on the head of the penis.
• At 3 degrees already observed inflammatory process in the vaginal environment. This is due to the fact that there is a change in the environment, it becomes alkaline, not acidic. Lactobacilli decrease in number, while microorganisms such as streptococci, staphylococci, fungi and E. coli, on the contrary, increase. The inflammatory process is also confirmed by increased leukocytes, there are more than 30 of them in the field of view. In this case, a woman may complain about the appearance of pathological symptoms, such as itching, burning and discharge from the genital tract.
• At 4 degrees the inflammatory process is already pronounced, there is a manifestation of dysbacteriosis, which is also called bacterial vaginosis. In this case, the medium will always be alkaline, shifted almost as much as possible in this direction. Lactobacilli are absent, and the flora is represented by a pathogenic group of microorganisms. Often you can see representatives of sexually transmitted infections, although there may be non-specific ones. The number of leukocytes increases significantly, can reach 50 or more. At grade 4, mandatory treatment is required even without the absence of symptoms on the part of the woman.

Why is the level of white cells elevated?

The reasons for the detection of an abnormal indicator of white blood cells are most often inflammatory processes:

• cervicitis (the process occurs inside the cervical canal);
• salpingoophoritis (ovaries and tubes);
• endometritis (the uterine mucosa suffers);
• vaginitis (intravaginal pathology);
• urethritis (inflammation affects the urinary tract).

Sexually transmitted infections also cause an increase in white blood cells. These include:

• genital herpes;
• cytomegalovirus;
• trichomonas;
• pale treponema;
• tubercle bacillus (Koch);
• mycoplasma, ureaplasma;
• gonococcus;
• chlamydia;
• fungi of the genus Candida, actinomycetes.

Exceeding the norm is detected during oncological processes in the organs of the reproductive system, dysbacteriosis of the vagina, intestines. And also high leukocytes in a smear appear during an exacerbation of an allergic process, endocrine pathologies, weakening of local and general immune protection, stress, physical overwork. Violation is detected in women after a miscarriage.

Interpretation of smear results

coccal flora

1. The coccal flora is large group microorganisms, which is a conditionally pathogenic flora for the human body. At the same time, it includes a variety of microorganisms, even on the mucous membrane. It has a specific shape for them, these are spherical or coffee bean-like bacteria, which are also called cocci.
2. In addition, this group may include absolute pathogens, such as gonococci. They should not be in the vagina of a healthy woman at all, and the detection indicates a sexually transmitted infection and is characterized by severe symptoms. They pose a great danger due to the development of complications.
3. Not always the detection of cocci in a smear on the flora indicates an inflammatory process, while it is worth considering that minor changes in the state of immunity, as well as violations of hygiene and nutrition lead to their rapid growth. They can be introduced from a sexual partner if sex is carried out without the use of protective equipment.

In a smear for flora from the cervical canal, coccal flora should not be detected at all.

The coccal flora on the vaginal mucosa is represented by both gram negative and gram positive microorganisms.

This is due to the fact that some bacteria are able to stain with a special dye that has a dark blue or purple color. Gram-positive microorganism in this case has a dark blue color, but negative ones have a lighter pink color.

Scientists have found that those bacteria that do not have the ability to stain are more resistant to the action of antibacterial agents. This will be due to the fact that they have a thick wall, so the dye, like the drug, is more difficult to penetrate into the cell cavity.

The most common gram positive include staphylococci and streptococci, which do not always give an inflammatory process in the vagina. And in a smear on the flora are contained in a single amount.

Gram-negative flora is more likely to cause vaginal disease. The most famous coccus is considered gonococcus.

Dederlein sticks

1. Dederlein's sticks are a bacterium that will be the basis for the microbiocenosis of the vagina. It belongs to lactobacilli, which have an anaerobic type of life activity. They are representatives of the obligate flora, this is due to their symbiotic variant of existence. In a small amount they can be found on the intestinal mucosa.
2. Their main function is the production of lactic acid, which helps maintain an acidic environment. It is this pH level that will be optimal to prevent the development of pathogenic microorganisms.
3. These bacteria have big sizes, relative to other representatives. In addition, they are unable to move. The vagina is represented by several species of the genus Lactobacilli. In the environment, they are extremely unstable, so they die quickly enough.
4. In addition, they cannot form a spore for subsequent protection in the environment. Sensitive to the action of chemical and physical factors. Life activity is also affected by the state of the body's immunity and metabolism. For its normal functioning, regular and good nutrition is required, as well as compliance with the rules of hygiene.

Leptothrix

1. Leptothrix- This is a bacterium that belongs to the representatives of conditionally pathogenic flora.
2. In the human body, they show vital activity on the mucous membrane of the oral cavity or vagina. They are Gram-negative.
3. They normally live and reproduce in an anaerobic environment. They live under anaerobic conditions.
4. They have the form of a long hair or a thin thread that has a thickened end. Externally form clusters that form loop-like fragments
5. Not capable of budding. Under environmental conditions, they divide and multiply, most often they can be found in a reservoir with fresh water or pool, sometimes found in ponds.
6. In the normal state of immunity, the development of the inflammatory process does not occur. But during the action of a provocative environmental factor, as well as a decrease in the body's defenses. Most often, the transmission method will be insufficiently pure water, the sexual route is also possible, but much less common.

In the absence of symptoms of pathology, the presence of leptothrix does not require additional treatment, but in the event of the development of the appearance of even a minor clinic, drug therapy is prescribed. The frequency of occurrence of this bacterium increases in the presence of HIV infection.

Urogenital infections caused by enterobacteria

Urogenital infections caused by enterobacteria - diseases, symptoms and causes

Diseases caused by gram-negative rods belonging to the Enterobacteriaceae family. Urogenital infections are caused by representatives of the genera Escherichia, Klebsiella, Enterobacter, Serratia, Hafnia, Salmonella, Edwardsiella, Citrobacter, Providencia, Proteus. Enterobacteria can be expelled from the vagina with vaginitis, cervicitis, or other inflammatory process. Very often they are found in combination with anaerobic microorganisms and Trichomonas. The presence of enterobacteria in the vagina is typical for women who do not follow the rules of personal hygiene.

E. coli (Escherichia coli) is one of the representatives of the normal intestinal flora, a saprophyte of the large intestine. Conditionally pathogenic and pathogenic serotypes of Escherichia coli cause the appearance of various pathogenetic and clinical forms of the infectious process. Their pathogenic features to a certain extent correlate with the presence of the corresponding antigen, i.e., with belonging to one or another serogroup. With urinary tract infections, serogroups 02, 06, 09 and others are found, with cholecystitis - 01, 08, 011, etc.

Coli-infection of the urinary tract is more common in girls and women, especially in the presence of vulvitis and vulvovaginitis.

The source of the disease is patients with coli infection or bacteria carriers of pathogenic serotypes of Escherichia coli. The mechanism of infection is fecal-oral, sometimes sexual. A hematogenous route of penetration of the pathogen into the kidneys and urinary tract from any extrarenal focus of infection is possible.

In adults, coli infection is most often manifested by inflammatory changes in organs located near the intestines - the urethra, bladder, vagina, uterus (urethritis, cystitis, pyelitis, pyelonephritis, colpitis, endometritis) or communicating with the intestines - gallbladder, bile ducts (cholecystitis, cholangitis). In children, coli infection can be localized in the lungs. Generalization of infection and development of sepsis are possible.

There are frequent cases when Escherichia coli in association with staphylococcus or some gram-negative bacteria (Proteus, Pseudomonas) causes nosocomial infections, in particular in gynecological clinics, in departments for newborns.

The final diagnosis of a disease caused by Escherichia coli can be established only on the basis of a bacteriological study, including the isolation of a pure culture of E. coli, its identification by morphological and biochemical characteristics, and the determination of a serogroup.

Antibiotics (polymyxin, ampicillin, tetracyclines, etc.) are used to treat coli infections.

Klebsiella pneumoniae, previously known as the causative agents of diseases of the respiratory system, is now often the cause of intrauterine infections that occur with damage to the respiratory and urinary tract. When grown on nutrient media, these bacteria form characteristic mucoid colonies; microscopy defines wide polysaccharide capsules around immobile cells.

Enterobacter aerogenes is found in urinary tract infections and in sepsis. Often they are motile, form slightly slimy colonies, and some strains form a capsule.

Serratia marcescens are small rods that can form an intense red pigment in cultures (a variable trait).

Representatives of the genus Serratia usually ferment lactose very slowly, some strains ferment urea (weakly). Unpigmented variants of these bacteria cause toxic sepsis.

Hafnia alvei is sometimes isolated, in addition to gastroenterocolitis, also in urethritis or vaginitis.

Bacteria from the genera Edwardsiella, Citrobacter are similar in biochemical properties; their pathogenicity has been problematic until recently. Certain serotypes are found in sporadic or mass food poisoning, urinary tract infections, etc.

Representatives of the genus Salmonella cause gastroenteritis, sepsis, endometritis, and urinary tract infections.

Providencia are biochemically similar to proteins, deaminate amino acids (for example, lysine), do not hydrolyze urea; they are detected in urinary tract infections, sepsis and other diseases.

transmission paths. Most bacteria of this family make up a significant part of the normal aerobic flora of the intestine and usually do not cause disease, but, on the contrary, are involved in ensuring its normal functioning. These microorganisms become pathogenic only when they penetrate into the tissues of the body, especially in the urinary and biliary tract, lungs, peritoneum or meninges, where they can cause an inflammatory process. They can penetrate into the bloodstream (when using venous or urethral catheters); get into the genitourinary tract during instrumental studies (nosocomial transmission); cause infectious lesions of the urinary tract after the introduction of contaminated drugs, especially after their intravenous use. Possible sexual transmission.

Epidemiology and general pathology. E. coli and some other bacteria of the Enterobacteriaceae family settle in the intestines of a child a few days after his birth and from that moment they form the main part of the normal aerobic microflora of the body. When inflammation occurs, regardless of the clinical picture of the disease and etiopathogenesis, a large amount of various kinds microorganisms. Within a short time, one of them begins to dominate, inhibiting the growth of others.

The dominant species causes about 80% of all bacteria. When the immune mechanisms of the body do not respond to any microorganism, the latter quickly takes root in the urinary system. For example, individuals with blood group III (B) do not produce antibodies against E. coli serotype 086 due to the identity of the antigens. According to clinical observations, such individuals are more susceptible to coli infections than people with other blood types.

Urinary tract infections may occur after bladder catheterization, bacteremia and urosepsis are possible. Often bacteremia is diagnosed in the bed prostate after surgery to remove it (adenomectomy) due to cystitis, atony Bladder, sometimes as a result of stone formation, narrowing of the urethra, resumption of past pyelonephritis, or asymptomatic bacteriuria. The infection can be introduced by an indwelling catheter during surgery or more often immediately after the intervention. Often lasts for months. With prostate adenoma, gram-negative bacteria are usually not isolated from the gland itself. However, infectious complications in the urinary system are caused by these microorganisms.

In some cases, patients with bacteriuria have elevated blood pressure. The reverse phenomenon is also observed: with increased blood pressure, bacteriuria develops, which can turn into pyelonephritis and complicate the course of hypertension. Therefore, when one of these states arises, it is necessary to assume the possibility of the development of another.

Bacteria of the family Enterobacteriaceae often cause secondary infections, including pneumonia, endocarditis, bacteremia, especially in drug users and in clinic patients.

Clinical manifestations. Manifestations of infections caused by bacteria of the family. Enterobacteriaceae depend on the localization of the pathological process. They cannot be differentiated from other bacterial infections on the basis of symptoms and signs of the disease alone, therefore it is very important to determine the causative agent of the genitourinary system infection, including the species and type characteristics, its amount in 1 ml of fresh urine and sensitivity to antibacterial agents. A systematic study of species, typical and other characteristics of microorganisms that cause infections of the genitourinary system is essential for elucidating the pathogenesis of uroinfections and determining methods for their therapy.

Diagnostics. Depending on the localization of the pathological process, genital secretions, urine, blood, cerebrospinal fluid, etc. are used for research. Gram-negative short rods that can form chains are found in stained smears; they are very similar to each other and only the presence of wide capsules is of diagnostic value for the genus Klebsiella. The test material is simultaneously applied to blood agar and media containing special dyes and carbohydrates, which allows you to quickly differentiate fermenting and non-fermenting colonies. Bacteria isolated on these media are further identified using biochemical and serological reactions. Rapid preliminary identification is possible by the ability of microorganisms to ferment lactose.

Treatment and prevention. Pronounced antimicrobial activity against bacteria of the family. Enterobacteriaceae have ampicillin, tetracyclines, aminoglycosides, gyulimyxins, sulfonamides. However, the sensitivity to these drugs in individual strains is different, so it must be determined by laboratory methods. Multidrug resistance is not uncommon.

In treatment, the effect can be achieved with the simultaneous use of aminoglycosides and furagin or ampicillin; trimethoprim with sulfamethoxazole and polymyxin. Other combinations of antibacterial agents are also advisable, the appointment of drugs that potentiate the action of antibiotics, increase the protective mechanisms of the patient's body, facilitate the delivery of antibacterial agents to the lesions and ensure their therapeutic concentration in tissues and blood serum. Prevention and effectiveness of the fight against these infections largely depend on keeping hands clean, strict adherence to the rules of asepsis and antisepsis (sterilization of instruments, disinfection of equipment), caution in prescribing intravenous drugs and personal hygiene of the genitourinary tract. It is very important to remember that many gram-negative bacteria are opportunistic pathogens and cause the development of the disease in a weakened body. AT medical institutions these bacteria are often transmitted by personnel and through instruments or parenteral preparations.

Frequent causative agents of urinary tract infections are bacteria of the genus Proteus from the fam. Enterobacteriaceae. These are gram-negative mobile aerobic rods; do not ferment lactose; produce urease, which leads to the rapid breakdown of urea with the formation of ammonia. They tend to "swarm" and quickly spread over the surface of a dense nutrient medium. The addition of phenylethyl alcohol or 0.1% chloral hydrate to the nutrient medium inhibits swarming. Proteas do not grow well in an acidic environment. transmission paths. Proteus, like other members of the family. Enterobacteriaceae cause disease in humans only when they go outside of their normal habitat (the digestive tract). There are also nosocomial transmission, the spread of infection through sexual contact, as well as in case of non-compliance with the rules of personal hygiene.

Epidemiology and general pathology. Proteas are often found in chronic urinary tract infections, as well as in bacteremia, pneumonia and focal lesions in debilitated patients or those receiving intravenous drugs. The first place among them is occupied by Proteus mirabilis, which is the only indolegative microorganism among the representatives of this genus. Then come Proteus morganii and Proteus rettgeri. Rarely isolated Proteus vulgaris.

We mentioned above the ability of proteins to form urease, which decomposes urea to ammonia, which contributes to the formation of phosphate stones. Ammonia is toxic to the kidneys, causes necrosis of the kidney tissue, microabscesses. Complement inactivation occurs in the urine. For bacteria, there is more opportunity to multiply unhindered in the kidney tissue, i.e., they become more invasive. Infections caused by urease-producing proteins cause more severe intoxication and destruction of the renal tissue.

Clinical manifestations. Bacteria of the genus Proteus are often found in complications of calculous pyelonephritis, congenital malformations, and after surgical operations. In these cases, various bacteria of this family are often isolated. Enterobacteriaceae. Subsequently, proteins are found in the urine, which cause a chronic, complicated course of urinary tract infection.

Treatment and prevention. Diseases caused by proteins must be treated with drugs that are sensitive to these microorganisms. It should be borne in mind that the sensitivity to antibiotics in different strains of Proteus varies greatly. The most active drugs are gentamicin and amikacin. The growth of P. mirabilis is often inhibited by penicillin and ampicillin. The appointment of cephalosporins (cefotaxime, or klaforan) is indicated.

Prevention of proteus infections, as well as other infectious diseases, should be carried out by organizing and conducting a set of measures aimed at identifying the source of infections, the mechanism of transmission and the susceptibility of the patient's body. The spread of infection must be stopped using aseptic and antiseptic methods. This fully applies to nosocomial infection caused by Proteus.

Deciphering indicators

Table for decoding indicators

Fecal analysis

How to detect overgrowth of Enterobacter cloacae? This can be done using stool or urine tests for bacteriological culture. Let's look at these studies in more detail.

The concentration of Enterobacter cloacae in the feces is determined during the analysis for intestinal dysbiosis. This study is prescribed if the patient has the following symptoms:

• prolonged temperature rise to +38 degrees;
• periodic vomiting;
• diarrhea;
• admixture of blood and mucus in the stool.

A small piece of biomaterial is taken for the sample, preferably with an admixture of mucus or blood (if any). Feces must be delivered to the laboratory within 1 hour. Specialists carry out sowing of faeces on nutrient media. After 5 days, the bacteria in the biomaterial begin to multiply. After that, the number of microorganisms in 1 g of feces is counted. Their concentration is measured in CFU (colony forming units).

Smear on flora during pregnancy

It is indicated to take all women who have been diagnosed with pregnancy. This is due to the fact that the course of pregnancy, as well as the development of the fetus, largely depends on the state of local immunity. The minimum is considered to be a double sampling of material.

1. During pregnancy, there is a decrease in immunity associated with hormonal changes, so there is a high probability that a woman will have a pathogenic flora. Violation of the flora in smears indicates a pathological process, which in most cases requires mandatory treatment. This is especially true for the detection of pathogenic flora, which, if retained on the vaginal mucosa during childbirth, can lead to infection of the fetus. Therefore, women take material and, if necessary, when planning natural childbirth, they sanitize the mucosa.
2. Most often in a pregnant woman in smears on the flora, a micelle of a yeast fungus is detected, which sometimes causes severe discomfort.
3. One of the most dangerous complications associated with a violation of the vaginal flora, are isthmic-cervical insufficiency, the penetration of pathogens to the fetal membranes, their inflammation and thinning.

As a result, we can conclude that this smear will be a very important diagnostic minimum for preventing complications, since with timely diagnosis, it is possible to prescribe a treatment that can normalize the condition.

Does the score change with age?

The number of leukocytes in smears should not differ greatly by age. In little girls, young women, and older women, normal values ​​may vary only slightly.

The result of the analysis directly depends on the hormonal background. Therefore, often in girls of puberty, an increased content of white blood cells in a smear is found. And also an increase in the number of protective cells above the norm occurs if the genitals of a child or girl become infected with pathogens. This happens when you violate the rules of individual hygiene, use someone else's towel, washcloth, linen.

Leukocytes in a stained smear

An abnormal phenomenon often accompanies a period of decline in reproductive function. A change in the hormonal balance causes dryness of the vaginal mucosa and injury to the walls of the organ due to itching. It also causes an increased amount of leukocytes found in the smear.

After the age of 50, many women's bodies produce more white blood cells than before. The analysis shows an excess of white blood cells by 1-2 units. Norms of leukocytes in the blood and urine in women.

A significant excess of the norm of leukocytes in a smear in an elderly woman signals a problem. Additional examination and treatment is required.

In some women, over a long period, tests may show the number of protective bodies in excess of the norm. At the same time, other tests do not reveal any signs of pathological processes in women. Polymerase chain reaction, enzyme-linked immunosorbent assay of blood show the norm. This condition does not require the appointment of drug therapy. But regular visits to the gynecologist and analysis of the vaginal microflora are required.

How to maintain the microflora of the vagina?

To maintain normal microflora, a woman needs to follow several rules:

• Regularly carry out hygiene measures using specialized products.
• Avoid frequent douching.
• Do not use drugs without a doctor's prescription.
• When having sexual intercourse with a non-permanent sexual partner, use barrier methods of contraception.
• Regularly conduct a gynecological examination and diagnosis for sexually transmitted infections.
• Monitor the state of immunity, as well as metabolism and endocrine pathologies.
• Maintain a diet.

pathogenicity

Under adverse conditions, Enterobacter cloacae microorganisms can cause inflammatory processes in various organs. This usually occurs with a sharp weakening of the body or against the background of other diseases. Bacteria can affect not only the gastrointestinal tract, but also other organs: lungs, kidneys, bladder. This leads to the appearance of the following pathologies:

• intestinal dysbacteriosis;
• acute pyelonephritis;
• cystitis;
• aspiration pneumonia.

Actively multiplying, enterobacters displace beneficial microorganisms. As a result, the microflora in the gastrointestinal tract is disturbed in humans. This leads to a deterioration in well-being, a further decrease in immunity and a high susceptibility to infections.

Bacterial vaginosis

Bacterial vaginosis is an imbalance of the vaginal microflora with single leukocytes and epithelial cells (pH over 4.5).

Bacterial vaginosis is a disease of polymicrobial etiology, which is recorded in 25 - 50% of women attending gynecological clinics.

Studies have found that bacterial vaginosis increases the risk of transmission of HIV and other sexually transmitted diseases.

Risk factors for its development include changing sexual partners, douching, smoking, and unsafe sexual practices.

Recurrent bacterial vaginosis is a serious problem for many women, with a recurrence rate of more than 50% of patients within 12 months of treatment.

Bacterial vaginosis is usually characterized by disturbances in the normal vaginal ecosystem, a decrease in the number of lactobacilli, as well as an increase in the number of various gram-negative and / or anaerobic bacteria.

A significant increase in vaginal anaerobes in bacterial vaginosis is associated with increased production of proteolytic enzymes and subsequent degradation of vaginal peptides to amines.

In an alkaline environment, amines become offensive, cause typical vaginal discharge, and trigger the release of pro-inflammatory cytokines such as IL-1β and IL-8.

Women with bacterial vaginosis usually complain of vaginal discharge with an unpleasant "fishy" odor. However, many women with bacterial vaginosis have no symptoms or complaints.

Release form and composition

The drug has the form of tablets, covered with a soluble film of beige color. Each includes:

• active substance (3 million IU);
• crystalline cellulose;
• povidone;
• crospovidone;
• silicon dioxide, dehydrated;
• magnesium stearate.

Tablets are packaged in contour cells of 5 or 10 pcs. The cardboard box contains 2 blisters. Tablets can also be supplied in glass jars of 10 pcs.

Pharmacological properties of Spiramycin

Pharmacodynamics

The drug belongs to the antibacterial agents of the macrolide group. In small and medium doses, it inhibits the reproduction of pathogenic microorganisms. In high doses, it promotes the death of bacteria. The substance is integrated into the 50S subunit of the bacterial ribosome and blocks the reactions of transpeptidation and translocation.

Unlike other macrolides, the drug is able to combine with several subunit components. A more stable connection with ribosomes provides a long bacteriostatic effect. The drug can accumulate in the bacterial cell in large quantities. The antibiotic is active against:

• staphylococci (including methicillin-sensitive strains of Staphylococcus aureus);
• streptococci;
• meningococci;
• gonococci;
• clostridia;
• diphtheria bacillus;
• chlamydia;
• mycoplasmas;
• treponema pale;
• leptospira;
• campylobacter;
• toxoplasma.

Haemophilus influenzae has variable sensitivity. The antibiotic has no effect on Enterobacteria and Pseudomonas.

Pharmacokinetics

The drug is rapidly absorbed, but only 10-60% of the active substance penetrates into the blood. It is distributed throughout the organs and tissues without getting into the cerebrospinal fluid and the brain.

A small part of the active substance interacts with plasma proteins. In the liver, the antibiotic is converted into active metabolites.

90% of the drug is excreted in the feces. The elimination half-life lasts 8 hours.

Indications for use Spiramycin

The drug is used for:

• acute community-acquired pneumonia (including those caused by mycoplasmas and chlamydia);
• acute inflammation of the mucous membranes of the bronchi;
• exacerbation of chronic bronchitis;
• sinusitis;
• angina;
• inflammation of the middle ear;
• chlamydial arthritis and conjunctiva;
• osteomyelitis and bacterial arthritis;
• bacterial lesions of the prostate;
• infectious urethritis (including chlamydial and gonorrheal);
• sexually transmitted infections;
• purulent lesions of soft tissues (infected allergic and psoriatic rashes, abscesses, phlegmon, erysipelas);
• toxoplasmosis (including in pregnant women);
• prevention of meningococcal lesions of the meninges in patients who have been in contact with the infected;
• prevention of rheumatic damage to the joints and soft tissues;
• elimination of the bacteriocarrier of whooping cough and diphtheria bacillus.

Contraindications

The list of contraindications to the use of Spiramycin includes:

• individual intolerance to the active substance and auxiliary components;
• lack of the enzyme glucose-6-phosphate dehydrogenase (the drug may contribute to the development of hemolytic anemia);
• blockage of the bile ducts.

Method of application and dosage of Spiramycin

For pneumonia and other infectious diseases, take 3 million IU of spiramycin 2-3 times a day. Tablets are drunk after meals. The daily dose should not exceed 9 million IU. The recommended daily dose for the prevention of meningococcal infections is 6 million IU. It is divided into 2 applications. The course lasts 5 days.

Side effects

While taking Spiramycin, the following undesirable consequences may occur:

1. Signs of damage to the gastrointestinal tract. Most often, nausea occurs, which may culminate in bouts of vomiting. Extremely rarely there is ulceration of the mucous membranes of the esophagus, stomach and intestines. Taking high doses of the drug in the treatment of cryptosporidiosis in AIDS patients may contribute to the perforation of the intestinal walls.
2. neurological disorders. Often there are headaches and dizziness. In rare cases, paresthesias, impaired coordination of movements, sleep problems, changes in taste and visual perception appear.
3. Signs of liver damage. Taking Spiramycin may contribute to a transient increase in liver enzymes and the development of non-infectious hepatitis.
4. Violation of the functions of the hematopoietic system. Rarely, acute hemolysis occurs. The drug may contribute to changes in the composition of the blood.
5. Cardiovascular disorders. Taking an antibiotic leads to a prolongation of the QT interval on the cardiogram.
6. Allergic reactions. When using Spiramycin, rashes like urticaria and skin itching occur. In rare cases, swelling of the face and larynx, anaphylactoid reactions develop.

Overdose

Overdose increases intensity side effects. When using large doses of the drug, diarrhea and persistent vomiting occur, consciousness is disturbed. No specific antidote has been found. If an overdose is suspected, the patient is hospitalized. In the hospital, symptomatic therapy is administered.

special instructions

Use during pregnancy and lactation

In the presence of strict indications, the drug can be prescribed to pregnant women. Active substance stands out with breast milk, so during the treatment breast-feeding suspend.

Application in childhood

Tablets are not prescribed to children under 12 years of age.

Use in the elderly

In the treatment of patients over 65 years of age, dose adjustment may be required.

For impaired renal function

In diseases of the excretory system, a dose reduction of Spiramycin is not required.

For impaired liver function

In liver diseases, constant monitoring of the activity of hepatic transaminases is required.

drug interaction

It is not recommended to use the drug in combination with drugs containing ergot alkaloids. When using an antibiotic in combination with levodopa and carbidopa, the half-life of the latter is extended. Since P450 isoenzymes are not involved in the metabolism of the drug, it does not react with theophylline and cyclosporine. The antibiotic is incompatible with alcohol, so during the period of treatment it is necessary to exclude the use of alcoholic beverages.

Analogues

The following medicines have a similar effect:

• Rovamycin;
• Spiramycin adipate.

Terms and conditions of storage

Tablets are stored in a dark place, avoiding overheating and moisture. Expiration date - 48 months from the date of production.