Gynaecological bacteriological tests at OpenMed Warsaw
Microbiological tests of material collected from the genital tract help to establish the cause of vaginal discharge, itching, burning, an unpleasant odour and recurrent intimate infections. At OpenMed Warsaw we carry out gynaecological diagnostics that include, among others, a vaginal swab and culture, material from the cervical canal, vaginal flora assessment (biocenosis) and GBS culture in pregnant women. The scope of testing can be matched to the symptoms and to previous treatment.
Gynaecological bacteriological tests in Warsaw
Bacteriological tests make it possible to check whether the material collected from the genital tract contains bacteria that may be responsible for inflammation. Depending on the problem, material is collected from, among others, the vagina, the cervical canal, the vaginal vestibule or the urethra. In pregnancy, a separate test is the vaginal and rectal swab for group B streptococci - GBS.
Several different methods can be used in diagnostics. Culture involves growing the microorganisms present in the sample, which makes it possible to identify them and, in certain cases, also to perform an antibiogram. Vaginal biocenosis, on the other hand, is based mainly on a microscopic assessment of the discharge and shows the proportions between the normal Lactobacillus flora and other microorganisms, as well as the presence of leukocytes, epithelial cells or fungal elements.
The same set of tests is not always needed. With recurrent discharge, the doctor may recommend a flora assessment, a bacterial culture and a mycological test at the same time, while if a sexually transmitted infection is suspected, additional molecular PCR tests may be needed.
Doctors diagnosing intimate infections at OpenMed
A culture or vaginal flora result is best assessed together with the symptoms and a gynaecological examination. OpenMed gynaecologists see patients with a first episode of infection, recurrent inflammation, abnormal test results and infections occurring in pregnancy. During the consultation the doctor can assess the nature of the discharge and the condition of the vaginal and cervical mucosa, choose the right sampling site and decide whether, in addition to a standard culture, a vaginal flora assessment, a mycological test or molecular diagnostics is needed.
Vaginal culture, cervical swab and vaginal flora assessment - how do these tests differ?
The names of these tests are sometimes used interchangeably, but they refer to different elements of diagnostics.
A vaginal or cervical swab describes primarily the method and site of sample collection. A sterile swab is used to collect a small amount of discharge or cells, which can then be used for a culture, a microscopic examination or a molecular test.
A vaginal culture involves placing the material on suitable media and observing the growth of microorganisms. It shows which bacteria or - in the case of a mycological culture - fungi have been grown from the sample. If a clinically significant microorganism is detected, its sensitivity to drugs can also be tested.
A cervical canal swab is taken from a different site than a typical vaginal swab. It may be indicated, among others, when cervicitis is suspected, before certain gynaecological procedures, or when the symptoms and the examination findings suggest that the material should come from the cervical canal itself.
Vaginal biocenosis is not a standard culture. The preparation is examined under a microscope for the composition of the bacterial flora, the number of Lactobacillus rods, leukocytes, epithelial cells, fungi and signs of a disturbed normal microflora.
When is it worth having a vaginal swab or culture?
The test is worth considering above all when symptoms appear that may indicate an intimate infection, or when complaints keep coming back despite previous treatment.
Common indications include:
- unusual, heavy, yellow, greenish, grey or lumpy discharge,
- a marked change in the smell of the discharge,
- itching or burning of the vagina and vulva,
- redness, swelling or irritation of the intimate area,
- pain or burning during intercourse,
- burning when passing urine,
- recurrent infections occurring several times a year,
- no improvement after previous antibacterial or antifungal treatment,
- an abnormal appearance of the discharge found during a gynaecological examination.
A culture may also be performed before selected gynaecological treatments and procedures and in certain situations related to pregnancy care.
With a first, typical episode of infection, a full set of tests is not always necessary. A culture is of greater diagnostic value, however, in recurrent or atypical infections, infections resistant to treatment or those with an unclear clinical picture.
Which intimate infections can bacteriological tests detect?
A culture makes it possible to detect bacteria that can grow under laboratory conditions. In material from the genital tract, the organisms identified may include Streptococcus agalactiae (GBS), Escherichia coli, Enterococcus spp., Staphylococcus aureus, Klebsiella spp., Proteus spp. and other aerobic or anaerobic bacteria - depending on the type of test used.
Finding bacteria does not, however, automatically mean an infection that needs treatment. The vagina is not a sterile environment. It is home to many microorganisms, and in women of reproductive age the normal flora consists mainly of lactic acid bacteria, Lactobacillus. This is why the laboratory result is interpreted together with the symptoms, the number of microorganisms detected, the sampling site and the findings of the gynaecological examination.
A standard culture also does not detect every cause of intimate infection. If infections such as Chlamydia trachomatis, Mycoplasma genitalium, Neisseria gonorrhoeae, Ureaplasma spp. or Trichomonas vaginalis are suspected, the doctor may recommend appropriate molecular tests, e.g. PCR. For this reason, a negative standard culture does not rule out every possible infection of the genital tract.
Vaginal bacterial flora and the vaginal cleanliness test
A normal vaginal microflora is a natural barrier against the overgrowth of pathogenic microorganisms. Lactobacillus rods are particularly important: they produce lactic acid and help to keep the vaginal environment acidic. In women of reproductive age, the pH of vaginal discharge is usually around 3.8-4.5.
A vaginal cleanliness or biocenosis test makes it possible to assess this balance. In the microscopic preparation it is possible to determine, among others:
- the number of Lactobacillus rods,
- the presence of other bacteria,
- the number of leukocytes indicating an inflammatory reaction,
- epithelial cells,
- the presence of yeasts and their structures,
- the presence of so-called clue cells, characteristic of the disturbed flora seen in bacterial vaginosis.
In a normal picture lactic acid bacteria predominate, and the numbers of other microorganisms and leukocytes are low. When there are few Lactobacillus and other bacteria begin to dominate, we speak of a disturbed biocenosis.
Not every abnormal result means that an antibiotic is needed. The significance of the result depends on the type of changes, the presence of symptoms, pregnancy and previous treatment.
Mycological culture and the diagnosis of vaginal thrush
The most common cause of vaginal thrush is yeasts of the genus Candida, above all Candida albicans. Infections caused by non-albicans species, e.g. Candida glabrata, are also possible; these may behave differently and be harder to treat.
Typical symptoms of candidiasis are intense itching and burning of the vulva, redness, swelling and thick, white or lumpy discharge. Unlike in bacterial vaginosis, the vaginal pH in candidiasis usually remains normal, below 4.5.
Material collected from the vagina can be assessed under the microscope and, if necessary, a mycological culture is performed, which allows yeasts to be grown and identified. Culture is particularly useful in recurrent, atypical or unsuccessfully treated infections, and when no fungi were found on direct examination despite persistent symptoms.
A positive culture does not always mean thrush that requires treatment. Candida can also be present in the vagina in women without symptoms. The diagnosis is therefore based on combining the result with the complaints and the gynaecological examination.
Testing for bacterial vaginosis
Bacterial vaginosis - BV - is not a typical infection caused by one specific species of bacteria. It involves a disturbance of the microbiological balance of the vagina: the number of protective Lactobacillus rods decreases, while the number of anaerobic bacteria increases, including Gardnerella vaginalis, Prevotella spp., Mobiluncus spp. and Atopobium vaginae.
The characteristic symptom is a uniform, greyish or whitish discharge with a strong odour, often described as "fishy". Itching and redness may be less pronounced than in thrush.
BV can be diagnosed using, among others, the Amsel criteria. They include:
- a uniform discharge coating the vaginal walls,
- a discharge pH above 4.5,
- the presence of clue cells in the microscopic preparation,
- a characteristic amine odour after an appropriate test.
Another method is the assessment of a Gram-stained preparation using the Nugent score. A score of 0-3 corresponds to Lactobacillus-dominated flora, 4-6 to intermediate flora, and 7-10 points indicates bacterial vaginosis.
Detecting Gardnerella vaginalis in a culture is not enough to diagnose BV, as the bacterium can also be present in women without symptoms. What matters is the assessment of the whole microflora, not the presence of a single species.
How is a vaginal or cervical swab taken?
The material is collected in the consulting room using a sterile swab. For a vaginal swab, the doctor collects discharge from the vaginal walls or the vaginal fornix. If the test concerns the cervical canal, the cervix has to be visualised with a speculum and the material taken directly from its canal.
The collection itself usually takes a few dozen seconds. It may cause brief discomfort related to inserting the speculum or touching the cervix, but it does not require anaesthesia.
After collection, the swab is placed in a suitable transport medium that protects the material until the laboratory test begins. For a culture, the sample is then placed on media that allow microorganisms to multiply. For biocenosis, a smear is prepared and assessed under the microscope.
When several tests are carried out at the same time, separate swabs may be taken - e.g. one for a bacterial culture, another for mycological diagnostics and another for a PCR test.
How to prepare for a bacteriological test?
Proper preparation reduces the risk of a result distorted by medication, intimate hygiene products, intercourse or bleeding.
Before the swab is taken, it is advisable to:
- avoid vaginal medicines, pessaries, creams and ointments for about 48 hours, unless the doctor has advised otherwise,
- abstain from intercourse for about 2 days,
- avoid vaginal douching,
- not use disinfectants or harsh cleansing products in the intimate area on the day of the test,
- plan the collection outside menstrual bleeding,
- have the material collected before starting antibiotic or antifungal treatment.
If an antibiotic has already been used, a follow-up microbiological test is usually performed at least 5-7 days after the end of treatment, unless the treating doctor recommends a different date.
If a gynaecological examination or a transvaginal ultrasound is also planned on the same day, the microbiological material is best collected before procedures that may change the amount or distribution of the discharge.
When material is collected from the urethra, it may also be advisable not to pass urine for about 2-3 hours before the test.
Antibiogram and mycogram - why do they matter when choosing treatment?
The culture itself answers the question of which microorganism has been grown. The next step may be to determine its sensitivity to drugs.
An antibiogram shows which antibiotics the isolated bacterium is sensitive to and which it is resistant to. The result may include designations such as S - susceptible, I - susceptible, increased exposure, and R - resistant, in line with the susceptibility interpretation standards used by the laboratory.
Thanks to this, in a clinically significant infection the doctor can choose a drug with a better chance of working, instead of trying one antibiotic after another without information on the sensitivity of the bacterium.
In the diagnosis of fungal infections, a similar role can be played by a mycogram, i.e. an assessment of the sensitivity of the cultured fungi to antifungal drugs. It is particularly important in recurrent or chronic candidiasis, infections caused by Candida species other than C. albicans, and when symptoms persist despite treatment.
Neither an antibiogram nor a mycogram is necessary with every sample. They are performed mainly when the cultured microorganism is clinically significant and the result may affect further treatment.
Bacteriological tests in pregnancy and GBS culture
One of the most important microbiological tests performed towards the end of pregnancy is a culture for Streptococcus agalactiae, i.e. group B streptococcus - GBS.
In line with the Polish standard of perinatal care, the test is performed between the 35th and 37th week of pregnancy. Material is collected from both the lower vagina and the anal area. It is a different test from the standard culture performed because of discharge or a suspected infection.
GBS can colonise the digestive tract and genital tract of a healthy woman without causing any symptoms. A positive result therefore means above all carriage, not a disease that requires routine treatment during pregnancy.
The information matters during labour, because the baby may come into contact with the bacterium in the birth canal. If the result is positive, appropriate antibiotic prophylaxis is given during labour in line with obstetric recommendations.
A GBS result should not be treated as interchangeable with an ordinary vaginal culture. The tests have a different purpose, a different collection method and a different clinical significance.
Your result - when should you discuss it with a gynaecologist?
The result of a microbiological test should not be interpreted solely on the basis of the words "positive" or "negative". What matters is the type of microorganism found, the sampling site, the amount of growth, the presence of symptoms and the result of the gynaecological examination.
A consultation is particularly advisable when:
- bacteria or fungi have been grown and there are symptoms at the same time,
- infections keep coming back,
- the result shows resistance to some drugs,
- there are symptoms despite a negative culture,
- a markedly disturbed biocenosis has been found,
- there has been no improvement after previous treatment,
- the patient is pregnant,
- there is also lower abdominal pain, bleeding or fever.
A negative culture does not always end the diagnostic process. With persistent symptoms, the cause may be, among others, microorganisms that require PCR diagnostics, a disturbed microbiota without a typical culturable infection, a skin condition of the vulva, chemical irritation or another gynaecological condition.
Nor should you start antibiotic treatment on your own based solely on the name of a bacterium on the result.
Price of bacteriological tests in Warsaw
The cost depends mainly on the type of test performed. A bacterial vaginal culture has a different scope from a mycological culture, a biocenosis, a combined test or a GBS culture.
For cultures, the extent of further laboratory diagnostics may also matter - e.g. an antibiogram for a cultured bacterium or a mycogram in certain fungal infections.
If you are not sure whether you need a culture, a biocenosis, a mycological test or broader diagnostics for an intimate infection, the scope can be agreed during a gynaecological consultation.
The current price of a specific test can be checked in the OpenMed price list or confirmed with reception on 22 100 45 20.
Where can you have a vaginal swab, culture or biocenosis at OpenMed?
We diagnose intimate infections at OpenMed Gynaecology and Obstetrics, ul. Wschowska 8, in the Wola district of Warsaw.
In one place, the patient can have a gynaecological consultation, choose the right type of test, have the material collected and, once the result is ready, discuss further management with the doctor.
This is particularly useful with recurrent infections, when a single result without knowledge of previous treatment and the clinical picture does not fully answer the question of what is causing the complaints.
Frequently asked questions about gynaecological bacteriological tests
Not quite. A swab means collecting material from the vagina with a swab. The collected material can then be used for various tests - including a bacterial culture, a mycological culture, a microscopic examination or a PCR test. A culture is therefore one of the methods of testing the collected swab.
Its main purpose is to assess the overall picture of the microflora rather than to identify every species precisely. The test assesses, among others, the amount of Lactobacillus, other bacteria, leukocytes, epithelial cells and fungal elements. If a specific bacterium needs to be identified, the doctor may recommend a culture or a molecular test.
In a standard culture, the microorganisms need time to grow in the laboratory, so the result is not available immediately. The first results are usually obtained after a few days. Diagnostics may take longer if additional identification of the microorganism or an antibiogram is needed.
A planned culture, biocenosis or diagnostic swab is usually not performed during menstrual bleeding, because blood can affect the quality of the sample and the microbiological assessment. However, if you have severe symptoms that require an urgent consultation, do not put off contacting a gynaecologist just because of your period.
Before a planned test it is best to abstain from sex for about 48 hours. Semen, spermicides and changes in the microflora related to intercourse can affect the material collected for testing.
Vaginal preparations can change the composition of the microflora and affect the result. It is usually recommended not to use pessaries, creams, ointments and other local preparations for about 48 hours before the sample is taken. If the medicine was prescribed by a doctor and treatment is ongoing, do not stop it on your own - the date of the test should be agreed with the doctor.
Not always. A standard culture detects only microorganisms that can be grown under specific laboratory conditions. Some infections - e.g. Chlamydia trachomatis or Mycoplasma genitalium - are diagnosed by other methods, most often molecular tests. If symptoms persist despite a negative result, further diagnostics may be needed.
No. Candida yeasts can also be present in the vagina in women without symptoms. A positive culture alone does not therefore determine the need for treatment. What matters are the accompanying complaints, the gynaecological examination, the fungal species and the previous course of the infection.
BV should not be diagnosed solely on the basis of the presence of Gardnerella vaginalis. Vaginosis is a disturbance of the whole vaginal ecosystem. Diagnosis uses, among others, the pH assessment, the appearance of the discharge, clue cells, the Amsel criteria and the Nugent score of the flora.
Usually not. A positive result means colonisation of the vagina and rectum by Streptococcus agalactiae. The woman may have no symptoms at all. The result matters mainly because it affects management during labour and eligibility for antibiotic prophylaxis that protects the newborn.
Not with every one. An antibiogram is performed mainly when clinically significant bacteria have been grown from the sample and assessing their sensitivity to antibiotics may help choose treatment. If the culture is negative or shows only typical physiological flora, there is no reason to perform an antibiogram.
Bacteriological tests price list
Service available at the following clinics:
- Warsaw Wola - price list
Have questions? Contact us - 22 100 45 20.