A smear is a type of examination, where a doctor collects a small amount of material from the mucosal surface. Smear test is most often used in urology for men and in gynecology for women. Smear examination for culture helps check for the presence of disease-causing bacteria and cancerous cells, and in some cases to evaluate the endocrine profile and the overall condition of the tissue. Vaginal smear for culture is taken once every three months during routine gynecological visits.
If you are undergoing treatment, smear for infection is taken after you finish your course of treatment to verify its success. Vaginal or cervical smear is a painless procedure that helps get an idea of a woman's health status.
Gynecological smear — 4 basic types:
1. Smear for culture.
2. Smear for infertility.
3. Smear for cytology (Pap test for abnormal cervical cells).
4. Smear for hidden infections (PCR).
1. Smear for Culture: Normal Range and Deviations from the Norm
Reasons for testing: this examination helps evaluate the microflora – the presence of disease-causing bacteria and their number.
When taken from a healthy woman, this test should show 95% of lactobacillus in the collected material. Lactobacillus produce lactic acid, thus protecting the reproductive organs from infections and maintaining proper acidity. The number of lactobacillus decreases for women "with child", therefore, the body's natural defense is weakened. To avoid the development of diseases caused by sexually transmitted infections, all future moms must do a smear test during pregnancy without exception.
Vaginal smears are tested to verify the absence of such infectious agents as, for example:
- Trichomonas vaginalis;
- Gardnerella vaginalis.
Smear for hidden infections is taken to identify infections that cannot be detected with culture analysis. One of the most widely used methods of detecting hidden infection is the PCR method.
Under normal conditions the microflora in a healthy woman's smear can contain both the Gardnerella vaginalis and the Candida, but their count should be low. The Gardnerella and the Candida begin growing rapidly when the body's immunity is decreased. The body's defenses can become weakened for numerous reasons:
- pregnancy;
- fatigue;
- emotional strain;
- presence of diseases that keep the body's immune system "busy".
Four categories of microbial quality are identified in evaluating the smear for culture.
- First. Reaction acidic — рН 4.0–4.5. The majority of microorganisms are Döderlein's bacilli (also known as lactobacilli), as well as a small number of white blood cells, epithelial cells. These results point to a healthy reproductive system.
- Second. Reaction acidic — рН 4.5–5.0. In addition to lactobacilli, the gram-negative bacteria are also present – most often those are infectious organisms that lose color after laboratory staining.
- Third. Reaction alkaline or subacidic — рН 5.0–7.0. Smear has mainly bacterial microflora, epithelial cells are also in large quantities. Several lactobacilli are detected.
- Fourth. Reaction alkaline — рН 7.0–7.5. Lactobacilli are absent; flora is represented by pathogenic organisms. There are large quantities of white blood cells in the smear. This smear analysis points to inflammation of the vaginal mucous membrane.
If you have poor results (3rd or 4th category), your doctor may have you repeat the culture test to confirm the results.
Smear for Culture: Interpretation
Smear results may be different in different laboratories. The norm might vary, depending on the lab where you performed your test. Given that any given lab can have different diagnostic techniques, smear test results will differ as well. Ideally, you should have all your tests done at the same laboratory, to be able to observe the changes over time without having those changes be influenced by the changing of labs where you undergo your tests. Smear test must be interpreted by the doctor.
CFU/ml is used to note the number of bacteria in urethral and vaginal smear tests, as well as in a cervical smear test. These units are read as the number of colony-forming units per milliliter of liquid.
2. Smear for Infertility
Reasons for testing: it helps determine the presence or absence of sexually transmitted infections, evaluate a woman's endocrine profile, as well as the composition of vaginal contents. During pregnancy smear results help identify a threatened miscarriage.
This test is called smear for purity, or vaginal smear "for infertility".
Smears are tested based on the following criteria:
- Squamous epithelium
Squamous epithelium are cells of the cervical and vaginal mucous membrane. A healthy woman's test must show small quantities of it. If there are no epithelial cells in the smear, it points to hormonal disorders, with androgen levels that are higher than normal, and estrogen levels that are below norm. Increased quantities of epithelial cells in the smear indicates inflammation.
Cervical smear with increased levels of squamous epithelial cells points to inflammations in the cervix, urethral smear – to inflammations in the bladder, vaginal smear – to inflammation of the vaginal walls.
Phases of the menstrual cycle also impact the squamous epithelial cell count. Your norm can differ, depending on the day that a smear test was taken.
If you submitted a smear for flora, it needs to be interpreted by your attending physician.
- Lactobacillus (synonyms: gram-positive rods, Döderlein bacillus)
Lactobacilli (rods) predominate in the smear, when reproductive organs are healthy. Smear test results, where 95% of all bacteria are lactobacilli, are considered to be good results. Sometimes with vaginal smear tests the lactobacillus count comes out below normal. When this happens, vaginal acidity also decreases, which makes it easier for disease-causing microbes to penetrate into the body.
- White blood cells (leukocytes)
One of the most important criteria in analyzing smears is the number of white blood cells in a smear.
White blood cells are the body's "protectors". Leukocytes are present in a smear in large quantities, when there are disease-causing bacteria that are actively growing inside an organism. In other words, the higher the concentration of white blood cells in a smear, the more severe is the inflammatory process.
If cervical smear contains up to 30 leukocytes, urethral – up to 5, and vaginal – up to 10, it is normal. These numbers are characteristic of sexually active women .
The above-normal levels of white blood cells in a smear only point to the presence of an inflammatory process. Your doctor must identify the cause of the infection. In order to do that, you will need to undergo additional examinations: a culture test, an immunoassay, and a polymerase chain reaction (PCR), for instance.
- Red blood cells
The number of red blood cells increases during periods, injuries to the vaginal mucous membrane, or an inflammation. Normal smear test may contain a few red blood cells.
- Mucus
Mucus is secreted by cervical and vaginal glands – vaginal and cervical smears should contain a small amount of mucus.
3. Smear for Hidden Infections and the Polymerase Chain Reaction
Reasons for testing: helps identify infections that cannot be detected with a smear tests for flora
In 1983, an American biochemist by the name of Kary Mullis developed the polymerase chain reaction method, which earned him the Nobel Prize. Thanks to the scientist, we now have the opportunity to identify bacteria and viruses even if they are in extremely small amounts. The polymerase chain reaction is often called a PCR diagnostic. The terms PCR test and PCR smear are also used. A smear, a scrape or a urine sample taken for analysis help identify hidden diseases.
The polymerase chain reaction is a biostudy method, whereby a region of DNA strand is amplified in a laboratory.
What is a PCR test used for? A smear analysis must identify the type of infection that is causing the disease. Sometimes, however, there are so few bacteria, that it is impossible to recognize them. That is where PCR diagnostic comes in.
To perform this test, a fragment of bacterial DNA is taken and cloned multiple times. When DNA is thus amplified, it becomes possible to identify which type of bacteria or fungus a lab technician is dealing with.
PCR diagnostic of infections yields precise results. It helps identify not only the genus but also the species of the bacteria: to be able to say, for example, not only that the fungus is genus Candida, but also that it is the Candida albicans species. If an infection is not identified precisely, the treatment might be ineffective. PCR diagnostic is often used for analyzing smears for sexually transmitted infections. The majority of venereal diseases, such as gardnerellosis, chlamydia, mycoplasmosis, gonorrhea, or ureaplasmosis can exhibit no symptoms in the early stages. The symptoms appear in later stages. Thanks to PCR test sexually transmitted infections can be detected in the early stages of their development and, consequently, can be cured faster.
This type of analysis can also help identify such viral infections as hepatitis or papilloma. Other methods can only detect the presence of the virus' waste products or antibodies against it, not the virus itself.
The polymerase chain reaction method helps identify infections in any environment: in blood, urine, saliva, on mucous membranes. Moreover, PCR test helps detect viruses in the ground and the water.
Benefits of the polymerase chain reaction:
• accuracy of infection identification;
• ability to identify the virus itself (rather than its breakdown products or antibodies);
• small quantities of test material are enough (even with just one germ cell);
• ability to detect infection in any environment (urine, blood, saliva);
• the speed of conducting the analysis;
• it is the only method for identifying certain infections.
4. Pap Test or Smear for Cytology
Reasons for testing: helps diagnose cervical cancer.
Pap Test has different names: smear for cytology, Papanicolaou test or smear, smear for atypical cells. The test was named after a Greek scientist, who was the first to use this method. To conduct a Pap test, a smear is taken from the cervical canal (cervix) during a gynecological examination on a chair.
Pap smear is a required yearly test for women over 30. Results of a cervical canal smear help diagnose cervical cancer – the second most frequent oncological disease among women.
How Is Smear for Cytology Taken?
Several factors can influence the results of a smear test. To obtain accurate results, avoid going to the bathroom for 2-3 hours prior to smear testing. Otherwise, you risk washing away the epithelium and bacteria that are important for analyzing vaginal smears.
To make sure your smear test results are accurate, you should adhere to the following for 48 hours prior to testing:
- do not engage in a sexual activity;
- do not douche (to avoid washing out vaginal contents);
- do not use vaginal contraceptives (spermicidal creams, ointments, foams);
- do not take baths;
- do not use tampons or vaginal suppositories.
The procedure of taking a cervical smear
Smear interpretation and, consequently, the success of treatment depend on how well a woman followed the aforementioned requirements. Papanicolaou smear can be done during any day of the menstrual cycle, when there is no menstrual discharge.
A gynecologist takes a smear during examination, while a patient is sitting on a gynecological chair.
Ayre spatula is a plastic stick for taking a cervical smear
To conduct the test, a doctor uses a gynecological mirror and an Ayre spatula – a special plastic stick. A smear test takes no more than two minutes. The procedure is painless.
Smear sampling is taken in three places – possible sites of infection: a smear is taken from the cervical canal (cervix), the vagina, and the urethral opening.
Smear sampling from the cervical canal
Smear analysis is performed by microscopic or culture examination. In most cases, women experience no discomfort following a smear test. Occasionally, though, some may experience vaginal spotting and painful sensations in the lower abdomen. Those should pass after a few hours.
There is no need to abstain from sex after a smear test. Specialists recommend that a woman undergo annual medical examination and do a smear for cervical cytology starting from the age of 18, even if she is not sexually active. Those who are sexually active are advised to visit a gynecologist as soon as they begin engaging in a sexual relationship, regardless of their age. After the age of 30, to be able to detect cervical cancer in early stages, you should undergo gynecological examination no less than two times a year.
Cervical Dysplasia
If a cervical smear for cytology yields abnormal cells, a doctor identifies it using a special term: dysplasia.
Dysplasia is a cervical condition, where part of the cells have abnormal structure. That means that these cells can mutate into cancerous ones. For that reason this pathology can be a precancerous condition.
What Impacts the Development of Cervical Dysplasia?
The pathology risk increases with the following factors:
- smoking;
- large number of births;
- prolonged use of intrauterine and hormonal contraceptives;
- vitamin deficiency;
- presence of sexually transmitted infections (especially, the papilloma virus);
- early sexual debut (prior to the age of 16);
- birth (prior to the age of 16);
- large number of sexual partners (three or more);
- genetic predisposition.
Cervical dysplasia is caused by the human papilloma virus (HPV) of types 6, 11, 16, 18, 31, 33, and 35.
Symptoms might include:
- frequent inflammatory processes;
- frequent inflammatory processes;
- bleeding after sexual intercourse or with the use of tampons.
Some women experience lower abdominal pain with dysplasia.
Dysplasia: Stages of Progression
Depending on how progressed dysplasia is, its stages of progression indicate the depth of tissue involvement. Three stages are identified: first, second and third.
Stages of cervical dysplasia
- Slight changes in cervical cell structure are classified as the first stage of dysplasia. Abnormal cells affect only the surface layer of the squamous epithelium.
- In the second stage of cervical dysplasia, abnormal cells affect the surface and central layer of the cervix.
- Third stage of cervical dysplasia means that the abnormal cells have spread to all three layers of the epithelium.
Cervical Dysplasia: Treatment
Cervical dysplasia. HPV— human papilloma virus
If you have been diagnosed with cervical dysplasia, your treatment will consist of reducing the number of abnormal cells. To do that, a doctor will cut out a small affected region of the cervix. If you have been diagnosed with cervical dysplasia, treatment cannot completely remove the human papilloma virus from the body. It can, however, prevent the development of a malignant tumor.
Treatment – removal of the affected region – of the uterus can be conducted by different methods: with the help of a laser, freezing or other methods. It depends on the woman's age, the degree of progression, and the condition of other reproductive organs. If a patient has sexually transmitted infections, those need to be cleared first. Treatment can begin only after a smear test shows no sign of sexually transmitted infections.
By identifying cervical dysplasia during early stages, treatment does not only help preserve a woman's health, but also save her life. Therefore, every woman must undergo routine examinations at least once a year.
Who Should Undergo Gynecological Examination?
Vaginal, urethral and cervical smears should be done by women, who:
- start being sexually active;
- became pregnant;
- are planning to become pregnant;
- have numerous sexual partners;
- experience discomfort in the reproductive organs (pain during sex, frequent
- urination or burning in the genitals, and others);м
- older than 18;
- are undergoing routine examination.
Regular examinations by a gynecologist, during which a smear test can be performed, help identify the onset of a disease in time, make a correct diagnosis, and even save a life. Cervical dysplasia, for example, whose treatment was started in time, will not grow into an incurable malignant tumor.
Smear: Normal Range and Deviations, or Who Falls into a High-Risk Group
Regardless of age, there are factors that increase the risk of developing cervical cancer. A combination of these factors and their prolonged "influence" on the body lower the body's defenses in fighting the disease even during its early stages.
Cervical smear for oncocytology is especially important for women, who:
- have several sexual partners;
- started being sexually active prior to the age of 18;
- had cancer of the reproductive system in the past;
- smoke;
- are viral infection carriers;
- have a weakened immune system.
Viral infections such as the herpes simplex virus, the HIV and the human papilloma virus increase the risk for developing cervical cancer .
Smear During Pregnancy
All women, regardless of whether or not they "have a bun in the oven", take the smear test for flora the same way. The only difference is in the frequency: pregnant women have the test performed more often.
Even if the mom-to-be had no recent illness, she could have caught an infection and been its carrier for a long time. And since the immune system is weakened during pregnancy, the bacteria might begin growing actively during that time.
Smear test before and after pregnancy can differ significantly. Even if there were no symptoms of a disease prior to pregnancy, sexually transmitted diseases quite often manifest themselves with the onset of pregnancy:
- gonorrhea;
- syphilis;
- ureaplasmosis;
- genital herpes;
- mycoplasmosis, etc.
If a pregnant woman is a carrier of one of the sexually transmitted infections, her smear test will most likely show an increased number of white blood cells. If a pregnant woman's smear shows an increased white blood cell count, her doctor must prescribe a course of treatment. Blood smear is also taken to determine an accurate diagnosis. This test is performed according to the same principle as the gynecological one. Blood smear helps identify such diseases as malaria, typhoid, etc.
| If white blood cells are discovered in a smear, a mom-to-be absolutely has to find out the cause of the inflammation and undergo treatment. |
Vaginal yeast infection develops rather frequently in pregnant women, thus an examination can also show an increased number of the Candida fungus.
What Should Not Be in a Smear Test?
To maintain proper function of the reproductive organs and the overall feeling of well-being, the organism needs to have a balance of good and bad bacteria. Smear for purity can contain small amounts or none of the following microorganisms and cell structures:
- Atypical cells. Can be indicative of a precancerous condition. Have abnormal structure.
- Clue cells. Clue cells in a smear are epithelial cells that have been bound by Gardnerella or other causative agents. An increased number of clue cells in a smear can be observed with compromised immunity. When smear is tested for flora, squamous epithelial cells that have been bound together with infectious agents are classified in this category.
- Gardnerella. These are small rods in a smear. Gardnerella may be present in small quantities in a vaginal smear. If a smear for purity reveals an increased number of these bacteria, it points to the development of a bacterial vaginosis. An increased number of these bacteria is also observed with vaginal dysbacteriosis.
- Candida. This fungus, like Gardnerella, are present in small numbers on the vaginal mucous membrane of healthy women. If the number of Candida fungi exceed those of lactobacilli, it leads to the development of vaginal candidiasis (commonly called the yeast infection). Gynecological smear confirms the disease in latent form if spores are present, and in active form if fungal hyphae are present. Generally, the number of candida increases when the body's immunity is compromised, including during pregnancy.
A healthy woman's vagina is home to up to 40 different types of bacteria. As long as the overall quantity of lactobacilli is greater than the rest, all the bacteria, including Candida and Gardnerella, are "peacefully" coexisting.
- Cocci (gonococcus, staphylococcus and other cocci in a smear)
In a smear cocci resemble spherical bacteria. A smear for purity may contain several types of cocci, but only extracellularly. If this is not the case, cocci in a smear point to a venereal disease.
- Gonococcus. Gram-negative bacteria that reproduces under the conditions of increased air humidity. In addition to gonorrhea, these types of cocci bacteria in a smear cause urethritis, cervicitis, salpingitis, and rectal inflammation.
- Staphylococcus. The most common — Staphylococcus aureus — is a gram-positive bacteria. 20% of the planet's population are carriers of this type of coccus. In a smear, bacteria related to this type of cocci cause slight skin infections (acne, etc.) and deadly diseases (pneumonia, osteomyelitis, endocarditis, etc.).
- Streptococcus. Gram-positive bacteria that live in large numbers in the gastro-intestinal tract (GIT) and respiratory passages, as well as in the nasal and oral cavity. If a pregnant woman's smear shows large quantities of streptococci, they can be the cause of a miscarriage, premature birth and still birth. In addition, they cause illnesses such as scarlet fever, bronchitis, strep throat, pharyngitis, etc. If streptococci are present in a smear in isolated numbers it can be considered normal.
- Enterococcus. Gram-positive bacteria that is part of the GIT microflora. It can withstand heating of up to 60 °С for a period of half an hour. If these cocci are present in a smear in large numbers, this points to inflammations of the urogenital system, pelvic organs and other diseases.
- Trichomonad. A smear for infections does not always detect the trichomonads, since this bacteria can have mutated forms. Bacterial culture is taken to confirm their presence.
Did your results come back poor, does your vaginal smear contain disease-causing bacteria? Nowadays, the majority of infections can be successfully treated. The important thing is not to indulge in self-treatment and follow your doctor's recommendations.
