Бак посев отделяемого из вагинального канала на инфекции мочевых путей (OYRON WELL D-ONE)

Microscopic examination of female urogenital tract secretions from three sites (vaginal, cervical, and urethral) evaluates the resident microflora. Also termed Gram stain of a urogenital smear or bacterioscopic smear analysis, the test supports assessment for bacterial vaginosis and recognition of select sexually transmitted infections, including candidiasis, trichomoniasis, and gonorrhea. It assists with differential diagnosis of disorders involving the genital and urinary tracts and is used to monitor treatment effectiveness in diseases of the urogenital tract. In obstetric care, a smear for microflora is recommended three times—at initiation of prenatal care, at 30 weeks, and at 36 weeks—and it is also applied in preconception assessment and in evaluating potential contributors to infertility and recurrent miscarriage.

The normal microflora of the female urogenital tract comprises approximately 40 microbial species. In women of reproductive age, lactobacilli dominate and typically account for 95–98% of the vaginal flora. The remaining 2–3% consist of conditionally pathogenic organisms, including staphylococci, streptococci, corynebacteria, klebsiella, Escherichia coli, Gardnerella, and a broad range of anaerobes (bacteroides, Prevotella, micrococci, Mobiluncus spp., enterococci, peptococci, peptostreptococci, Veillonella, clostridia, eubacteria, Campylobacter, and fusobacteria). Yeast-like fungi of the genus Candida may also be present in small numbers. Lactobacilli help maintain colonization resistance by producing hydrogen peroxide and lactic acid. In the presence of glycogen, this activity sustains an acidic environment (pH 3.8–4.5) that suppresses overgrowth of conditionally pathogenic and pathogenic microbes. While low-level colonization with conditionally pathogenic species is typically harmless, various factors can disrupt this balance and favor overgrowth: reduced immune function, stress, metabolic disorders, exposure to broad-spectrum antibiotics, anti-inflammatory, immunosuppressive, or hormonal therapy, hormonal transitions (menarche, pregnancy, menopause, postpartum, or postabortion), and inadequate intimate hygiene. A decline in lactobacilli can lead to vaginal dysbiosis with expansion of conditionally pathogenic bacteria; without timely management, sequelae may include inflammatory disease of external and internal genital organs (e.g., endometritis, salpingitis, oophoritis), pregnancy complications, miscarriage, and infertility. Microscopic analysis of smears in women provides a semiquantitative appraisal of overall microbial load in the vagina, cervix, and urethra; characterizes the composition of the flora; detects specific pathogens associated with sexually transmitted infections (notably trichomoniasis and gonorrhea); and evaluates the vaginal epithelium and the intensity of inflammation via leukocyte response. Smears are stained by the Gram method to rapidly categorize bacteria as gram-positive or gram-negative. In gynecologic specimens, the typical normal pattern is gram-positive rods consistent with lactobacilli (lactomorphotypes). Microscopy serves as an initial screening approach; definitive pathogen identification with antimicrobial susceptibility testing requires culture. Viruses, Chlamydia trachomatis, Mycoplasma, and Ureaplasma are not visualized by this method, and nucleic acid amplification tests or immunoassays are used for diagnosis of these infections. The composition of the microflora varies across the menstrual cycle, underscoring the need to follow collection guidelines.