Vaginal discharge consists mainly of water mixed with electrolytes, microorganisms, epithelial cells and organic compounds such as fatty acids, proteins and carbohydrates. The vaginal fluid is formed from blood serum in the area of the vaginal mucosa, which seeps out of the capillaries through the intercellular channels. Less fluid is removed from the bartholin glands, cervix, endometrium and fallopian tubes. Cell elements are exfoliated cells from the cervical columnar and vaginal squamous epithelium. White blood cells (white blood cells) are present only in small numbers in women without vaginitis.
VAGINOUS MICROFLORA: FEATURES
The vagina is not a sterile cavity of the female body. It is inhabited by beneficial bacteria. Estrogen and pH are two important factors that affect the types of bacteria present in the vaginal flora. The content of lactic acid in the vagina provides an acid pH of less than 4.5 in adult women. Lactic acid is produced as a result of the metabolism of Lactobacillus and vaginal epithelial cells as a result of the breakdown of glycogen. Low pH promotes the growth of acidophilic organisms such as Lactobacillus, but it inhibits the growth of most other bacteria. Lactobacillus appears to be central to limiting the growth of other bacteria. Lactobacillus is also able to produce hydrogen peroxide, which inhibits the growth of bacteria that do not contain catalase. All this allows you to protect the female genital area from infection. Therefore, when studying a vaginal smear, it practically does not have white blood cells, which are markers of the inflammatory process.
NORMAL VAGINAL MICROORGANISMS
Between 5 and 10 types of microorganisms can be detected in the vagina of women, and the focus is on the number of bacteria. The presence of the main and “intermediate” flora was revealed depending on the lifestyle, sexual activity and age. Lactobacilli are predominant in the microflora. In addition, the presence of Gardnerella vaginalis, Enterococcus, and Ureaplasma urealyticum is possible. In this normal flora, only 1 to 5% of the concentration is made up of potentially pathogenic aerobic bacteria and mycoplasmas, such as Staphylococcus aureus, Group B streptococci, Escherichia coli, or some of the potentially pathogenic anaerobes. If pathogenic growth occurs against the background of suppressing beneficial microflora, inflammation occurs and the level of leukocytes rises.
REASONS FOR DEVIATIONS AS A RESULT OF THE BUTTER
In cases of the development of bacterial vaginosis (vaginal dysbiosis), the number of Lactobacillus is significantly reduced and the concentration of G.vaginalis, anaerobic gram-negative rods and Prevotella species increases.
When the complex balance of microorganisms changes, potentially pathogenic microorganisms that are part of the normal flora, such as Candida albicans in cases of candidiasis and G. vaginalis and anaerobic bacteria in cases of bacterial vaginosis, multiply to a concentration that causes symptoms. Little is known about the factors that contribute to the growth of normal flora. Pathogenic exogenous sexually transmitted microorganisms such as Trichomonas vaginalis, N. gonorrhoeae and C. trachomatis can also cause infection. All this leads to a change in the composition of the smear, the appearance of a large number of white blood cells in it.
HOW DOES THE DIAGNOSIS BE?
Diagnosis of vaginitis cannot be based solely on the presence or absence of symptoms. In women with vaginitis, various manifestations are possible, which provide a significant coincidence with the symptoms that occur in women without infection or vaginitis.
Physical and laboratory parameters, not symptoms, should be used to diagnose vaginitis by doctors.
With the exception of certain individuals with typical and well-defined symptoms of candidiasis, self-diagnosis is even more inaccurate.
The diagnosis of vaginitis is largely based on a microscopic examination of a vaginal smear. The specificity is almost 100% when trichomonads, key cells or hyphae are detected. If the diagnosis cannot be made with certainty, separate cultures and re-examination should be performed a few days later, at least for women with suspected vaginitis to make a specific diagnosis, and for women with symptoms of presumably normal discharge to further rule out vaginitis. Two studies with normal results theoretically increase the accuracy of diagnosis in both categories to 96%.
The whole result as a whole is evaluated – the level of leukocytes, bacteria, cells and physico-chemical parameters.
INSPECTION AND DIAGNOSTICS
First of all, a woman should be examined for the presence of external signs of inflammation (redness, swelling) or cracks that may occur with candidiasis and contact dermatitis, to identify other lesions – warts, cysts, cancer. Liquid vaginal discharge is often present in women with trichomoniasis or bacterial vaginosis.
Normal vaginal discharge is usually white and lumpy, and they combine into lumps. Discharges from bacterial vaginosis are gray and uniform, and they are present on the front and side walls of the vagina. Candida can cause the formation of “curd” plaque on the wall of the vagina, and trichomoniasis often provokes purulent discharge. The characteristics of vaginal discharge are not typical, as a rule, the diagnosis cannot be made solely by the appearance of the discharge, since most women do not have “typical” complaints.
SINGLE AND MULTIPLE LEukocytes in a smear in women
Single white blood cells may be present in the vagina as a result of physiological discharge from the cervix, especially in the premenstrual period, but their number usually does not exceed the number of vaginal epithelial cells. A large number of white blood cells suggests trichomoniasis, cervicitis, or sometimes candidiasis. Women with desquamative inflammatory vaginitis also have a large number of white blood cells.
During the early estrogen-dominant phase of the menstrual cycle, clear mucous endocervical secretions are normal. In the later phase of progesterone, the cervical mucus is thick, scanty or not visible. Vaginal discharge on the neck should be checked for purulent discharge from the vagina (a mixture of white blood cells and bacteria). The presence of purulent discharge in the endocervical canal should prompt the diagnosis of cervicitis. N. gonorrhoeae and C. trachomatis are present in approximately half of women with cervicitis. With cervicitis, endocervical bleeding can occur with a smear from the cervix due to excessive friability of the columnar epithelium.