Бак. посев отделяемого из уретры на микрофлору с определением чувствительности к антибиотикам

Microscopic examination of female urogenital secretions (vaginal, cervical, and urethral Gram-stained smears; bacterioscopy; urogenital smear for microflora) characterizes the vaginal microbiota and inflammatory response. The test supports diagnosis of bacterial vaginosis and identifies infections detectable on smear such as vulvovaginal candidiasis, trichomoniasis, and gonorrhea, while aiding the differential evaluation of genital and lower urinary tract disorders. It is used to monitor response to therapy for urogenital tract infections and to assess reproductive health in women planning pregnancy and during prenatal care, with smear microscopy recommended three times in pregnancy (at initial visit, 30 weeks, and 36 weeks).

The healthy vaginal ecosystem comprises roughly 40 microbial species. In women of reproductive age, lactobacilli predominate and account for about 95–98% of the flora. By producing lactic acid and hydrogen peroxide in the presence of glycogen, lactobacilli maintain an acidic milieu (pH = 3.8–4.5) that suppresses overgrowth of opportunists and limits colonization by pathogens. The remaining 2–3% consists of conditionally pathogenic organisms, including staphylococci, streptococci, corynebacteria, Klebsiella, Escherichia coli, Gardnerella, and a range of anaerobes (Bacteroides, Prevotella, Micrococcus, Mobiluncus, Enterococcus, Peptococcus, Peptostreptococcus, Veillonella, Clostridium, Eubacterium, Campylobacter, Fusobacterium). Yeasts of the genus Candida may also be present in small numbers. Reduction in lactobacilli can destabilize this community, leading to dysbiosis and expansion of opportunistic microbes. Triggers include immunosuppression, stress, metabolic disorders, broad-spectrum antibiotic exposure, anti-inflammatory, immunosuppressive, and hormonal therapies, as well as hormonal transitions (menarche, pregnancy, menopause, postpartum, postabortion) and inadequate hygiene. Without timely management, such imbalance may contribute to inflammatory disease of the genital tract (e.g., endometritis, salpingitis, oophoritis), complications of pregnancy, miscarriage, and infertility. Microscopic analysis of vaginal, cervical, and urethral smears provides a semiquantitative estimate of total bacterial load, delineates flora composition, and evaluates epithelial status and the degree of inflammation by the leukocyte response. Gram staining facilitates rapid classification of organisms as gram-positive or gram-negative; in normal gynecologic smears, gram-positive rods representing lactobacilli (lactomorphotypes) predominate.