Vaginal Flora Smear in Women: What the Test Shows and How to Read the Report Form

A flora smear is a common test at a gynecological appointment. It helps the doctor check for bacterial vaginosis and other infections and understand the cause of complaints. It is best to go over the report form with a doctor: the numbers make sense alongside symptoms and examination findings.

What a flora smear is and why it is taken

This is a laboratory test of genital tract discharge. For complaints of changes in discharge, the doctor may order an examination, including taking a smear. If bacterial vaginosis is suspected, the doctor examines the area and may run a cotton swab over the discharge inside the vagina to check for vaginosis and other infections. The doctor aims to confirm bacterial vaginosis and rule out sexually transmitted infections, not to make a diagnosis from a single line on the report form.

How the examination is performed

The material is sent to a laboratory. For bacterial vaginosis, the Amsel criteria are used—a set of clinical signs—and for differential diagnosis, a molecular biological test called "Florocenosis" is used.

What the values on the report form mean

The report form describes a picture; it does not pass a verdict. In a healthy woman, the vaginal flora consists mainly of Döderlein bacilli: they produce lactic acid, and the acidic environment prevents colonization by pathogenic and opportunistic microbes. Inflammation of the vaginal mucosa is called colpitis. The doctor assesses the remaining values on the report form together with complaints and examination findings: thresholds may differ between laboratories.

• Döderlein bacilli are the basis of healthy flora and produce lactic acid.
• The acidic environment of the vagina hinders the multiplication of pathogenic microbes.
• Colpitis is inflammation of the vaginal mucosa.
• The doctor assesses the remaining lines of the report form together with complaints and examination findings.

What changes in the smear indicate

Bacterial vaginosis is a disruption of the natural balance of bacteria in the vagina. It is not a sexually transmitted infection, but sexual activity can trigger it. It occurs more often in sexually active women, when changing partners, when using an intrauterine device, and when using perfumed products in the vaginal area. Half of women have no symptoms, and discharge may be grayish-white, thin, and fish-smelling. Colpitis can be caused by chlamydia, trichomonas, mycoplasmas, streptococci, and staphylococci; it is promoted by sexually transmitted infections, prolonged antibiotic use, mucosal damage, reduced immunity, and poor hygiene.

When to see a doctor

There are no uniform timelines for a smear: the doctor orders it according to indications. For changes in discharge, itching, burning, pain, or abnormal bleeding, the doctor may order an examination, including taking a smear. If you are pregnant and notice changes in discharge, discuss this with your doctor or midwife: in most pregnancies bacterial vaginosis does not cause problems, but in a small proportion of cases complications are possible. If inflammation of the vaginal mucosa is not treated, the process may spread to the cervical canal, uterus, and adnexa.

A change in the smear by itself is not a reason to call an ambulance. 103/112 — for signs of stroke or heart attack (chest pain) and other life-threatening conditions.

This text is for reference: it helps you understand what a flora smear shows, but it does not replace a doctor's consultation and discussion of your report form with a gynecologist.

This content is for reference and does not replace a doctor's consultation. Medical disclaimer