Гинекологический мазок (3 точки - U,C,V)

Microscopic examination of female urogenital microflora from three sites (vagina, cervix, urethra) is used to assess the overall microbial composition and balance of the lower genital tract. The test, also known as a urogenital smear for flora or Gram‑stained bacterioscopy, supports the diagnosis of bacterial vaginosis and can reveal selected sexually transmitted infections, including candidiasis, trichomoniasis, and gonorrhea. It assists in the differential diagnosis of genital and urinary tract disorders, is used to monitor response to therapy, and is incorporated into obstetric care (at initial prenatal visit and at 30 and 36 weeks) and preconception evaluation. The assay also contributes to the investigation of infertility and recurrent pregnancy loss.

The vaginal ecosystem comprises approximately 40 microbial species. In reproductive‑age individuals, lactobacilli predominate, typically accounting for 95–98% of the flora. Opportunistic organisms represent roughly 2–3% and may include staphylococci, streptococci, corynebacteria, Klebsiella, Escherichia coli, Gardnerella, and various anaerobes (such as Bacteroides, Prevotella, Mobiluncus, enterococci, peptococci, peptostreptococci, Veillonella, clostridia, eubacteria, Campylobacter, and fusobacteria); small numbers of Candida species can also be present. Lactobacilli help maintain a protective environment by producing hydrogen peroxide and lactic acid, which, in the presence of glycogen, sustain an acidic pH of 3.8–4.5 that limits overgrowth of opportunists and suppresses pathogens. Shifts in host or environmental factors—reduced immune function, stress, metabolic disturbances, exposure to broad‑spectrum antibiotics, anti‑inflammatory, immunosuppressive, or hormonal therapy, physiologic hormonal transitions (menarche, pregnancy, menopause, postpartum, postabortion), and inadequate hygiene—can diminish lactobacilli and enable expansion of opportunistic microbes. Resulting dysbiosis may contribute to inflammatory disease of the external and internal genital organs (including endometritis, salpingitis, and oophoritis), adverse pregnancy outcomes, miscarriage, and infertility if not addressed promptly. Microscopic evaluation of smears from the vagina, cervix, and urethra provides a semiquantitative view of microbial burden, characterizes the flora, and can identify certain sexually transmitted pathogens such as Trichomonas vaginalis and Neisseria gonorrhoeae. The examination also assesses the condition of the vaginal epithelium and estimates inflammatory activity by leukocyte response. Gram staining facilitates rapid categorization of bacteria; in typical gynecologic smears, normal flora appears as gram‑positive rods consistent with lactobacillus morphotypes.