Smear on the degree of purity elevated leukocytes. Causes of an increase in the level of leukocytes. About the diagnostic method

A smear (bacterioscopy) is a type of analysis in which the composition of secretions from the mucous membranes of the vagina, cervix and urethra is studied. Taking a smear is a quick and painless procedure. The resulting secretions are examined for the presence of leukocytes in the laboratory using a microscope.

A detailed description of the norms of smear results in women can be found in a special table. Depending on the day of the menstrual cycle, the age and state of health of the woman, the norm indicators will differ.

Only a gynecologist or urologist can send for analysis.

The main reasons for taking a smear:

• vaginal discharge that has an atypical color, smell and texture;
• burning, pain and itching in the vagina;
• pain when urinating;
• irritation and redness of the skin on the genitals;
• taking antibiotics for 10 days or longer;
• pregnancy planning;
• suspected sexually transmitted infection.

Women who have a regular sex life are recommended to take preventive tests once a year. The microflora of the vagina is an ideal environment for the development of inflammatory processes, and regular examination will help to detect and cure the disease in time, if it appears.

Preparation for analysis

Collection of secretions is similar to a regular examination at the gynecologist. To do this, you need a spatula and a gynecological mirror. Spatula - a thin plastic stick, one end of which is slightly expanded. The doctor inserts it into the vagina and runs the tip of the spatula along the cervix with a gentle brushing motion. He puts the secretions taken in this way on a special glass.

From the vagina, the discharge is collected on a gauze swab, and a smear from the urethra is taken using a bacteriological loop. To find out if the number of leukocytes in a smear is normal, women can use a special table of results posted on the Internet, or ask your gynecologist. To get the correct results, you need to prepare for the analyzes.

A smear is not taken during menstruation. It is advisable to take tests 2-3 days before the start or after the end of menstruation, and not in the middle of the cycle. This will give you more accurate results.

Also you can't:

• have sexual intercourse 2 days before the analysis;
• use suppositories, lubricant and cream 1 day before analysis;
• douche 1 day before analysis;
• wash before taking with the use of detergents;
• visit the toilet 3 hours before the test.

What tests can detect an increased number of leukocytes

3 types of analysis can detect an increased number of leukocytes.

The composition of the microflora

If a genitourinary infection is suspected, the gynecologist prescribes an analysis of the composition of the microflora. It includes epithelial cells and opportunistic bacteria - pathogens. Normally, bacteria are absent or present in an amount of 1-2 units.

For the degree of purity

The purity of the vagina is a conditional concept.

Depending on the amount and composition of microflora, 4 degrees of purity are distinguished:

1. Complete absence of pathogenic flora and leukocytes;
2. Normal number of leukocytes and a slight presence of microflora;
3. The level of leukocytes is increased, pathogenic bacteria are present, repeated tests are required to clarify the diagnosis;
4. All indicators are elevated, there are no bifidobacteria capable of normalizing the condition of the vagina, the patient needs emergency treatment.

Oncocytology

Oncocytological examination allows early detection of precancerous cells in the epithelium of the cervix and vagina. Doctors strongly recommend that all women, upon reaching the age of 18, regardless of their state of health and lifestyle, take an analysis for oncocytology once a year.

Deciphering the results of the analysis

Analyzes can detect bacteria and white blood cells in a smear. The norm in women (a table of normal indicators is given below), varies depending on the place of taking the analysis, age and sexual activity.

In the composition of the secretions may be found:

• Lactobacilli. Their presence in the vagina is the norm. A small number of lactobacilli is a symptom of bacterial vaginosis;
• Gonococcus. Normally absent, cause gonorrhea;
• Cocci. They can be Gram-positive and Gram-negative; gram-positive: staphylococcus, streptococcus and enterococcus should be present in the vagina, but their increased number indicates kalpitis;
• Yeast. In a small amount, they are constantly in the vagina, the rate increases with the development of candidiasis;
• key cells. They are formed as a result of the connection of squamous epithelial cells and gardnell, their presence means the development of gardnerellosis or vaginosis;
• Leptothrix. The bacterium that causes candidiasis is not normally present;
• Trichomonas. Normally absent, causes chlamydia;
• Escherichia coli. The presence in a single number is acceptable, the accumulation of E. coli bacteria often indicates a neglect of personal hygiene;
• flat epithelium. Low values ​​indicate atrophy of the epithelial layer, high values ​​indicate the presence of inflammation.

The norm of leukocytes in a smear in women

Ideally, leukocytes should be absent, but such indicators are extremely rare. Even in girls who are not sexually active, viruses and bacteria in a smear can be detected.

Table

The table shows the norms of the results of the diagnosis of leukocytes.

Norm before menstruation

In healthy women, the number of leukocytes before menstruation does not increase. Only 1% of patients are characterized by an increase in the level of leukocytes by 2-3 units. During menopause, the indicator within the normal range can rise to 20 units.

Norm after menstruation

Normally, the number of leukocytes in a smear in women should not change significantly after menstruation. The table with normal indicators is an open source of information, it can be found on the Internet and the results can be compared. Significant an increase in the level of leukocytes may be associated with non-compliance with the rules of personal hygiene.

If a girl is washed irregularly and uses low-quality tampons, bacteria will actively multiply in the vagina and cause inflammation.

Norm during pregnancy

During pregnancy, a woman's immune system is put under a lot of stress and an increase in the level of leukocytes up to 20 units is considered the norm. If the indicators are higher, it is necessary to urgently undergo a course of treatment. Any inflammation in the body is dangerous for the child, and diseases of the reproductive system - especially.

Norm after childbirth

During childbirth, a woman loses a lot of blood. This is a serious shake-up for the body, for which it is preparing in advance. A few days before delivery, white blood cells accumulate in the area of ​​the uterus, and elevated levels of white blood cells within 4-5 days after birth is the norm. If after 5 days the level of leukocytes has not decreased, this indicates the presence of postpartum complications.

Causes of an increase in leukocytes

An increased level of leukocytes is observed in various diseases of the genitourinary system, some of them require medical treatment or surgery. The slightest manifestation of characteristic symptoms is a reason to consult a gynecologist.

Genitourinary infection

Urinary infections are called cystitis and urethritis - inflammation of the walls of the bladder and urethra. They are manifested by frequent urges, sharp pains during urination, fever. The causes of diseases are hypothermia and neglect of hygiene rules.

About 80% of women suffer from cystitis at least once in their lives, without proper treatment it becomes chronic and can cause more serious diseases.

Thrush

Vaginal candidiasis or thrush - a disease in which vaginal discharge acquires a specific structure - becomes compacted, similar to cottage cheese. They have an unpleasant sour smell. If the discharge is not washed off the external genital organs in time, they cause itching and redness.

Candida fungi are always present in the microflora of the vagina. Candidiasis develops when the number of Candida fungi increases by 3-4 times. A smear on leukocytes will allow not only to see the causative agent of the fungus, but also to determine its type and reaction to drugs.

Allergic vulvitis

In allergic vulvitis, inflammation occurs as a result of the action of an allergen. Most often, they become poor-quality linen and inappropriate hygiene products.

Vulvitis can be hidden, and its active manifestations include:

• redness and swelling;
• pain sensations;
• rash;
• purulent discharge.

Allergic vulvitis is primarily a disease of the external genital organs. But without proper treatment, inflammation can go into the vagina. To find out if vulvitis has provoked internal inflammation, an analysis is performed on the number of leukocytes.

Trichomoniasis

The causative agent of trichomoniasis is Trichomonas vaginalis. This is a viral disease that most often develops in parallel with other infections: gonorrhea and chlamydia. Trichomoniasis is sexually transmitted, the risk of infection through unprotected contact exceeds 80%.

The disease is manifested by pain and redness of the genital organs. Atypical discharge often appears: frothy, green or yellow. Trichomoniasis disrupts the composition of the vaginal microflora, which leads to inflammation and an increase in the number of leukocytes by 2-5 times.

Latent infections

Normal white blood cell counts are easy to find on the Internet at the appropriate request in the form of a table. In women, hidden infections can increase the rate of leukocytes in a smear tenfold, so it is important to know these rates and be able to independently decipher the results. This will allow the patient to more competently approach treatment and follow the recommendations of the doctor.

Latent infections are asymptomatic and a smear is the only way to detect them. With its help, the type of causative agent of the infection and its amount in the composition of the microflora are established. Sometimes the disease is caused by pathogens of different types, and in the course of treatment it is required to combine several drugs.

Vaginitis

Vaginitis is a disease in which the mucous membrane of the vagina is exposed to negative effects and reacts to it with inflammation. It can be caused by hormonal disruptions, taking antibiotics that affect the composition of the vaginal microflora, infection with a virus from a partner. With vaginitis, the symptoms appear chaotically, and often women do not pay attention to them.

Like any inflammation, vaginitis is dangerous with complications. A smear will help to accurately determine the presence of an infection and a specific pathogen.

Gonorrhea

Gonorrhea most commonly affects young women between the ages of 20 and 35. It is an infectious disease transmitted through sexual contact. Infection is possible even through oral sexual contact, since gonorrhea affects all the mucous membranes of the body.

The first symptoms of gonorrhea are pain in the lower abdomen and yellowish vaginal discharge. But recent data show that Increasingly, women are experiencing asymptomatic gonorrhea.. It affects the internal organs and can cause infertility. In this case, only a general smear and further tests clarifying the diagnosis can detect gonorrhea.

Erosion

According to statistics, erosion occurs in more than 50% of women. This is a small red area on the cervix, resulting from a hormonal failure. To diagnose erosion, you will need not only to take a smear for leukocytes, but also to undergo video colposcopy - a study using a miniature camera. Erosion is successfully treated, but without treatment it can turn into an oncological disease.

Herpes

The herpes virus is ubiquitous and affects about 90% of people. But most of them are carriers - they do not get sick themselves, but transmit the virus to their sexual partners. The herpes virus is transmitted not only through sexual contact, but also through kissing, using common personal hygiene products and utensils.

Herpes is manifested by a rash and redness: small bubbles filled with liquid appear on the external genitalia. With herpes, the level of white blood cells drops, and this can reveal a complete blood count. A smear for leukocytes should be taken to clarify the diagnosis.

Oncology

The main symptom of cancer is pain and bloody discharge from the vagina. But they are also a symptom of many other diseases, and a smear is necessary to establish the correct diagnosis.

Medical treatment

To achieve the rate of leukocytes in a smear indicated in the table in most women without chronic diseases is obtained quickly. A course of antibiotics can cure almost any urinary tract infection. Only in particularly difficult cases, long-term treatment is required, consisting of several courses.

To treat an elevated level of leukocytes, use:

• Antiseptics. They are used to disinfect the vagina and external genitalia. The solution is injected into the vagina and washed. Popular antiseptics: "Miramistin" and "Chlorhexidine";
• Antibiotics. They are prescribed to suppress pathogenic microflora. But, since the antibiotic also destroys the beneficial microflora, it should be used carefully and in short courses. These antibiotics include: "Furagin", "Palin", "Azithromycin";
• Aminoglycosides(antibiotics prescribed only in a hospital setting). These are powerful antibiotics. They can only be used under the constant supervision of specialists, since they have a long list of contraindications and can cause severe allergic reactions;
• Immunomodulators. They are used as an aid to improve the performance of antibiotics. Universal immunomodulator - "Vitaferon". It does not cause allergic reactions and contribute to the speedy recovery of beneficial microorganisms;
• Preparations for the prevention of dysbacteriosis. These are immune-supporting drugs that do not allow antibiotics to change the composition of the vaginal microflora too much. Most often, experts recommend "Laktovit".

ethnoscience

Alternative methods of treatment cannot be a full-fledged replacement for medicines, but are often used as an adjuvant.

Reducing the level of leukocytes contributes to:

• Douching. To douche, you will need a swab: a sterile bandage twisted into a tight roll. With the help of a tampon, the treatment solution is introduced into the vagina. As a solution, you can use a decoction of chamomile or calendula. A tablespoon of finely chopped dry grass should be poured with 200 ml of boiling water, covered with a lid and left to cool completely. Strain the finished broth. Before insertion into the vagina, it is advisable to heat the decoction to a comfortable warm temperature in order to avoid discomfort;
• baths. Therapeutic bath is useful as a disease prevention, and in the process of treatment it is used as a stimulant. To prepare the bath, you will need 20 g of dry laurel leaves. They need to pour a glass of boiling water, strain and dilute the broth in 10 liters of water. The water will cool quickly, but you can not add it. This will break the concentration of the decoction, so such a bath should be taken no longer than 10 minutes;
• Decoctions for oral administration. A woman can obtain the normal level of leukocytes in a smear corresponding to the normal level of leukocytes indicated in the table with the help of herbal decoctions. A decoction of St. John's wort has proven itself well. 1 teaspoon of dry grass is poured with boiling water and insisted under the lid for 15 minutes. Ready broth is taken 3 times a day. The duration of the course of treatment is 10 days, if necessary, repeated after a break of 1 week.

Many diseases of the female genital organs are asymptomatic, and regular testing for the level of leukocytes is the only way to detect them at an early stage. Gynecologists recommend undergoing a complete examination at least once a year, and in the presence of chronic diseases - 2 times a year.

Video on the topic: the norm of leukocytes in a smear in women

The norm of leukocytes in a smear in women according to the generally accepted table:

Rules for taking and deciphering a smear analysis in women:

Diagnosis of gynecological diseases is carried out using a smear, which is taken to identify pathogenic microorganisms, bacteria and measure the acidic environment of the vagina. The procedure is carried out using special sterile instruments, after which the biological material is sent to the laboratory for research.

Laboratory tests in gynecology are mandatory and additional: for preventive and diagnostic purposes, a smear is mandatory, and if necessary, more detailed studies are prescribed, such as cytology and bacterial culture.

Bacterioscopy

Taking a smear on the flora is also called a bacterioscopy or a general smear. Deciphering such an analysis makes it possible to determine:

• the composition of the microflora of the vagina, cervix and urethra;
• the presence of pathogenic microorganisms (gonococci, Trichomonas and fungi);
• localization and intensity of the inflammatory process in the genital organs.

Bacterial culture

This is a laboratory analysis of the genital organs, in which the biological material is placed in a nutrient medium in order to grow and study pathogenic bacteria. After a laboratory study, a conclusion is made about the type of pathogens and their susceptibility to antibiotics.

Bacterial culture is prescribed after receiving a smear, in cases where coccus sticks and other pathogenic microorganisms are found. Also, bacterial culture is carried out with frequent inflammation of the urinary tract.

Cytology

Tests for cytology in gynecology is a laboratory study of the epithelium of the internal genital organs.

Scraping for cytology is prescribed in two cases: for the study of hormonal disorders and for oncological tests.

With hormonal disorders in a woman's body (for example, with amenorrhea), smears are taken 5-6 times throughout the entire menstrual cycle. Based on changes in the epithelium, conclusions are drawn about the hormonal function of the ovaries.

If there is a suspicion of oncological processes with severe erosion, scraping is carried out from the cervix.

When to take a smear for flora

Taking a gynecological smear is a mandatory procedure when visiting a antenatal clinic. Using this procedure, changes in the bacterial environment of the vagina and urethra are monitored, which can lead to pathological processes.

A gynecological smear is most informative for the following symptoms:

• itching and discomfort;
• discomfort after intercourse;
• pain during and after urination;
• unusual discharge;
• bad smell;
• lower abdominal pain.

A gynecological smear on the flora makes it possible to diagnose such diseases:

• thrush or vaginal candidiasis;
• bacterial vaginosis, or dysbacteriosis;
• tyrhomoniasis;
• gonorrhea.

An analysis of the microflora must be carried out once a year, during a medical examination. If a bacterial infection or inflammatory process is detected in the results of the analysis, the study is repeated after the course of treatment.

How to properly prepare for an analysis

In order for the analysis to be the most informative, it is necessary to adhere to a number of rules before the procedure:

• you can not carry out the procedure during menstruation;
• abstain from sexual intercourse for 48 hours;
• for 2 days of scraping, you can not douche;
• do not use vaginal suppositories on the eve of the smear;
• do not take a bath;
• exclude the use of any means of intimate hygiene for several days;
• 3 hours before taking a scraping, you should exclude visiting the toilet.

These precautions are necessary so that on the day of the procedure the flora is the most natural, which will allow us to estimate the number of opportunistic and beneficial microorganisms.

How to take a swab

The scraping procedure is painless, performed using a gynecological speculum with an expander and takes 2-3 minutes.

Using a special disposable brush, the gynecologist takes biological material in three places: from the urethra, vagina and cervix. The swabs are then examined in the laboratory.

In the results, when deciphering the smear analysis for flora, Latin letters are indicated, which indicate the place where the smear was taken:

• Vag (V) - vagina;
• Ur (U) - urethra or urethra;
• Cer (C) - cervix.

Deciphering the smear norm for flora in women (table)

Deciphering a smear for flora in women includes the following data: epithelium indicators, mucus assessment, the presence of gonococci, Trichomonas and Candida fungi, as well as an assessment of the number of Dederlein sticks.

Leukocytes- These are the formed elements of the blood that are able to protect the body from viruses and bacteria. If the level of leukocytes rises, this indicates inflammatory processes in the genital or urinary organs.

If the leukocytes in the smear exceed the permissible limits, this may indicate inflammation of the vaginal mucosa (colpitis), uterus (endometritis), uterine appendages (adnexitis). It is also possible to increase the number of white blood cells in the urethra with inflammation of the urethra (urethritis).

Epithelium. The internal genital organs of a healthy woman are covered with a thin layer of epithelial cells. If the amount of epithelium exceeds the norm, this indicates hormonal failures.

In this case, there is a violation of the desquamation of the internal mucous membrane, and several balls of epithelial cells are formed one on top of the other. In the case of increased indicators of the epithelium in the smear, a cytological examination is prescribed for the flora.

Slime is the result of the secretion of the glands of the cervical canal. The greatest amount of mucus is concentrated on the cervix, which contributes to the penetration of spermatozoa. The absence of mucus indicates violations of the uterine glands.

The detection of mucus in the urethra may be a sign of inflammation of the urinary system, since normally there is no mucus in the urethra.

Gonococci(cocci sticks) - bacteria that cause gonorrhea (a sexually transmitted disease). The presence of gonococci in the genitals requires mandatory treatment.

Trichomonas are the causative agent of trichomoniasis. One of the signs of the disease may be small ulcers in the vagina, which can be detected during examination. In most cases, when pathogenic bacteria are detected in the flora, several types of microorganisms are detected at once.

key cells. In gynecology, epithelial cells are called key cells that are altered due to the influence of pathogenic bacteria, fungi, or microflora disturbances. The presence of key cells in the smear indicates thrush or dysbacteriosis.

Candida fungi(Candida) - pathogenic fungi that are always present in the human body and, at the same time, their presence is not indicated in the transcript of the smear.

Microflora. The composition of the normal microflora in the female reproductive system is quite diverse. 90-95% of beneficial bacteria are lactobacilli Lactobacillus (or Dederlein sticks).

Lactobacilli produce special lactic acid, which lowers the ph of the vagina to 3.8-4.2. Increased acidity is necessary so that weak and slow sperm cannot fertilize the egg. Dederline sticks also produce hydrogen peroxide, which serves to protect the uterus from pathogenic microorganisms.

The composition of the normal microflora also includes some conditionally pathogenic microorganisms (mycoplasmas, gardnerella, streptococci, ureplasmas, staphylococci). These microorganisms in a smear of a healthy woman are in a small amount (1-2% of the microflora) and do not require treatment, since pathogenic rods are controlled by lactobacilli and the woman's immune system.

The flora of the vagina is unstable and depends on the phase of the woman's menstrual cycle. In the first half of the cycle, especially during menstruation, the number of Dederlein sticks decreases, as a result of which both acidity and susceptibility to pathogenic microorganisms change.

A few days before ovulation, Dederline's sticks multiply as much as possible, protecting the genitals from pathogenic bacteria and fungi.

Smear on flora during pregnancy

The results of tests in a pregnant woman practically do not differ from the value of normal indicators. The flora of the vagina in pregnant women consists of a larger number of Dederlein sticks, the occurrence of which is due to the influence of the following factors:

• lack of critical days;
• the need for enhanced protection of the internal genital organs (including the fetus) from the penetration of pathogenic microorganisms.

To detect pathogenic bacteria in pregnant women, a smear is taken several times during pregnancy. The procedure is carried out in order to exclude the development of diseases caused by gonococci, staphylococci and Trichomonas, since infections can lead to miscarriage or infection of the child.

The degree of purity of the vagina

Based on the data on the state of the microflora, a conclusion is made about the degree of purity of the vagina. In this case, cleanliness refers to the high level of Dederline sticks and the absence of pathogenic microorganisms in the vagina of healthy women. There are 4 degrees of purity.

• Normocenosis or 1 degree of purity. In a smear from a healthy woman, there is a normal epithelium and a large number of Dederlein sticks. Acid-base balance is normal, acidic environment (ph - 3.8-4.2).
• Carrier or 2 degree of purity. A small amount of opportunistic microorganisms is found in the scraping, leukocytes are within the normal range, but the ph remains slightly acidic.
• Dysbiosis or bacterial vaginosis. Smear analysis shows most of the cocci, key cells, leukocytes, and fungi. Useful lactobacilli are found in insufficient quantities. Ph changes to a slightly alkaline reaction and is represented by indicators of 5.0 - 5.5.
• At the fourth degree of purity, lactobacilli are not observed in the results. In the microflora, only pathogens are found (coccal flora, key cells, Trichomonas and many leukocytes). The vaginal environment becomes alkaline (ph 6.0-6.5).

Flora smear analysis is one of the most important diagnostic methods in gynecology. The smear is taken from the mucous membrane of the vagina, cervix or urethra. This analysis allows you to assess the state of the microflora of the genitourinary system and identify the presence of pathogenic microorganisms.

A smear analysis for flora in women is performed during a preventive examination by a gynecologist and in the presence of complaints from the genitourinary system. These include: pain in the lower abdomen, itching, burning in the vagina, discharge, indicating a possible inflammatory process. It is also advisable to do this analysis at the end of the course of antibiotic therapy in order to prevent thrush and when planning pregnancy.

What is this analysis for?

Usually, a vaginal swab is part of a routine medical check-up for women. It is performed by a specialist during a gynecological examination. Also, biological material is taken from the urethra and cervix.

This diagnosis allows you to detect possible problems with women's health, such as an inflammatory process or a disease caused by an infection. In medical terminology, such a study has another name - bacterioscopy.

A gynecological smear is taken if the following diseases are suspected:

• or vaginitis;

Specialists can prescribe a smear with the following complaints of the patient:

• Pain during intercourse.
• Foul-smelling copious discharge with a change in color.

A smear is taken when planning pregnancy and after antibiotic therapy. In addition, the smear allows you to monitor the effectiveness of therapy in the treatment of gynecological diseases.

Advantages of the method:

• Painless procedure.
• Simple rules for preparing for a smear.
• Monitoring the effectiveness of the treatment of women's diseases.
• Ability to identify many diseases of the genitourinary system.

With a preventive purpose, women periodically need to carry out this diagnosis. This will help prevent possible unwanted consequences.

Preparation for delivery

Some doctors say that this analysis does not require special preparation, however, this is not so. For the reliability of the results, the patient is advised not to go to the toilet for 2-3 hours, since urine can wash away all pathogenic bacteria and infections, it will be difficult for the attending physician to determine the causes of your pathological condition.

Douching, vaginal suppositories and antibacterial soap also contribute to unreliable indicators. Women should definitely take this analysis after the end of menstruation, and besides, all patients should refrain from any sexual contact 2 days before taking the biomaterial.

How to give up?

The analysis is most often taken by a doctor when you come to him for a regular appointment at a polyclinic or when you simply go to a paid laboratory where obstetricians and medical staff take biomaterial from you.

A gynecologist, obstetrician or any other medical worker lightly passes a special disposable stick-shaped spatula over three points - the vagina, urethra and cervical canal.

In men, the urologist or other doctor inserts a special disposable probe into the urethra, rotates around the axis several times and takes an analysis. It is believed that the study does not cause pain, however, this does not exclude the negligence of the doctor, as well as individual sensitivity or the presence of a particular disease, which can cause discomfort.

The meaning of the letters on the analysis form

Doctors do not use full names, but abbreviations - the first letters of each of the analysis parameters. To understand the normal microflora of the vagina, knowing the letter designations will be very helpful.

So what are these letters:

1. abbreviations of the zones from which the material is taken are denoted by the letters V (vagina), C (cervical part of the neck) and U (urethra or urination canal);
2. L - leukocytes, the value of which may not coincide in normal and pathological conditions;
3. Ep - epithelium or Pl.ep - squamous epithelium;
4. GN - gonococcus ("culprit" of gonorrhea);
5. Trich - Trichomonas (causative agents of trichomoniasis).

In a smear, it is possible to detect mucus, indicating a normal internal environment (PH), useful Doderlein sticks (or lactobacilli), the value of which is equal to 95% of all beneficial bacteria.

Some laboratories make it a rule to put marks in relation to the content of a particular type of bacteria. For example, somewhere they use the “+” sign for this. It is put down in 4 categories, where one plus is insignificant content, and the maximum value (4 pluses) corresponds to their abundance.

In the absence of any flora in the smear, the abbreviation “abs” is affixed (Latin, this type of flora does not exist).

What do doctors not see with microscopy?

With the help of this analysis, it is impossible to determine such conditions or diseases of the body:

1) Cancer of the uterus and cervix. To diagnose a malignant degeneration of the endometrium, histological material is needed, and in large quantities. And they take it directly from the uterus with separate diagnostic curettage.

2). To determine it, a smear is not needed and no matter what result it will show. It is necessary to take a blood test for hCG, undergo a gynecological examination with a doctor or do an ultrasound of the uterus. You can determine the chorionic gonadotropin in the urine, but not in the discharge from the genitals!

3) CC and other pathologies (, leukoplakia, koilocytosis, HPV lesions, atypical cells, etc.) are put according to the results of a cytological study. This analysis is taken directly from the cervix, from the transformation zone, according to a certain technique with Papanicolaou staining (hence the name of the analysis - PAP test). It is also called oncocytology.

4) Does not show infections (STDs) such as:

• (chlamydia);
• (mycoplasmosis);
• (ureaplasmosis);

The first four infections are diagnosed by PCR. And it is impossible to determine the presence of the immunodeficiency virus by a smear with high accuracy. You need to take a blood test.

Smear norms for flora

After receiving the results of the tests, it is sometimes very difficult to understand the numbers and letters written by the doctor. In fact, everything is not so difficult. In order to understand whether you have gynecological diseases, you need to know the norm indicators when deciphering the smear analysis for flora. There are few of them.

In the analysis of a smear in an adult woman, the normal indicators are as follows:

1. – must be present, but only in small quantities.
2. (L) These cells are allowed as they help fight infection. The number of leukocytes in the vagina and urethra is not more than ten, and in the cervical region - up to thirty.
3. (pl.ep.) - normally, its amount should be within fifteen cells in the field of view. If the figure is higher, then this is evidence of inflammatory diseases. If less - a sign of hormonal disorders.
4. Dederlein sticks - a healthy woman should have a lot of them. A small number of lactobacilli indicates a disturbed vaginal microflora.

The presence of fungi of the genus Candida, small rods, gram (-) cocci, Trichomonas, gonococci and other microorganisms in the results of the analysis indicates the presence of the disease and requires a deeper study and treatment.

Table for decoding the smear norm in women (flora)

The interpretation of the results of the smear analysis for flora in women is presented in the table below:

Degrees of purity by smear on flora

Depending on the results of the smear, there are 4 degrees of purity of the vagina. Degrees of purity reflect the state of the microflora of the vagina.

1. First degree of purity: The number of leukocytes is normal. Most of the microflora of the vagina is represented by lactobacilli (Doderlein sticks, lactomorphotypes). The amount of epithelium is moderate. Mucus - moderately. The first degree of purity indicates that everything is normal: the microflora is in order, immunity is good and inflammation does not threaten you.
2. Second degree of purity: The number of leukocytes is normal. The microflora of the vagina is represented by beneficial lactobacilli along with coccal flora or yeast fungi. The amount of epithelium is moderate. The amount of mucus is moderate. The second degree of purity of the vagina is also normal. However, the composition of the microflora is no longer ideal, which means that local immunity is reduced and there is a higher risk of inflammation in the future.
3. Third degree of purity: The number of leukocytes is above normal. The main part of the microflora is represented by pathogenic bacteria (cocci, yeast fungi), the number of lactobacilli is minimal. There is a lot of epithelium and mucus. The third degree of purity is already inflammation that needs to be treated.
4. Fourth degree of purity: The number of leukocytes is very large (the entire field of view, completely). A large number of pathogenic bacteria, the absence of lactobacilli. There is a lot of epithelium and mucus. The fourth degree of purity indicates severe inflammation that requires immediate treatment.

The first and second degrees of purity are normal and do not require treatment. At these degrees, gynecological manipulations are allowed (cervical biopsy, curettage of the uterus, restoration of the hymen, hysterosalpingography, various operations, etc.)

The third and fourth degrees of purity are inflammation. At these degrees, any gynecological manipulations are contraindicated. You need to treat the inflammation first, and then retake the smear.

What is coccal flora in a smear?

Cocci are bacteria that have a spherical shape. They can occur both in normal conditions and in various inflammatory diseases. Normally, single cocci are found in the smear. If the immune defense is reduced, the amount of coccobacillary flora in the smear increases. Cocci are positive (gr+) and negative (gr-). What is the difference between gr+ and gr- cocci?

For a detailed description of bacteria, microbiologists, in addition to indicating the shape, size and other characteristics, stain the preparation using a special method called "Gram stain". Microorganisms that remain stained after washing the smear are considered "gram-positive" or gr+, and those that become discolored when washed are "gram-negative" or gr-. Gram-positive bacteria include, for example, streptococci, staphylococci, enterococci, and lactobacilli. Gram-negative cocci include gonococci, Escherichia coli, and Proteus.

What are Doderlein sticks?

Doderlein sticks or, as they are also called, lactobacilli and lactobacilli are microorganisms that protect the vagina from pathogenic infections by producing lactic acid, which helps maintain an acidic environment and destroy pathogenic flora.

A decrease in the number of lactobacilli indicates a disturbed acid-base balance of the microflora in the vagina and its shift to the alkaline side, which often occurs in women who are sexually active. The pH of the vagina is significantly affected by both pathogenic microorganisms and opportunistic pathogens (which are sometimes found in the vagina normally).

Smear on flora during pregnancy

The microflora of each woman is strictly individual, and normally consists of 95% of lactobacilli that produce lactic acid and maintain a constant pH of the internal environment. But in the vagina there is also a conditionally pathogenic flora. It got its name because it becomes pathogenic only under certain conditions.

This means that while an acidic environment is present in the vagina, the opportunistic flora does not cause any inconvenience and does not actively multiply. These include yeast-like fungi, which under certain conditions can cause vaginal candidiasis, as well as gardnerella, staphylococci, streptococci, which under other conditions can cause bacterial vaginosis (inflammatory process) in a woman.

A woman's flora can change for a variety of reasons - with a decrease in immunity, taking antibiotics, with common infectious diseases and diabetes. One such factor that can change the microflora is a change in hormonal levels. So, in a pregnant woman, until the end of pregnancy, estrogens are practically not produced, but the hormone progesterone is produced in large quantities. This hormonal background allows Doderlein's sticks to increase 10 times, so the body tries to protect the fetus from possible infection during pregnancy. Therefore, it is very important to undergo an examination before the planned pregnancy and determine the degree of purity of the vagina. If this is not done, then during pregnancy the opportunistic flora can be activated and cause various diseases of the vagina.

Candidiasis, bacterial vaginosis, bacterial vaginosis, gonorrhea, trichomoniasis - this is a far from complete list of diseases that weaken and loosen the walls of the vagina. This is dangerous because ruptures can occur during childbirth, which might not have happened if the vagina were clean and healthy. Diseases such as mycoplasmosis, chlamydia and ureaplasmosis are not detected by smear analysis, and these pathogenic microorganisms can only be detected by a PCR (polymerase chain reaction) blood test using special markers.

A smear analysis from a pregnant woman is taken at the time of registration, and then for control at 30 and 38 weeks. Usually, to assess the state of the microflora of the vagina, doctors talk about the so-called degrees of purity of the vagina, which a woman must know and ensure that the necessary degree is maintained during pregnancy.

A gynecological smear allows you to identify a whole list of diseases of the reproductive system. With its help, the presence of pathogenic microbes, blood elements, epithelial cells and other indicators in the vagina is determined. The number of leukocytes in a smear allows you to identify the presence of infectious and inflammatory diseases, as well as determine the severity of their course.

And now let's dwell on this in more detail.

What are leukocytes?

Leukocytes are called white blood cells. This group includes a whole list of cells that perform a protective function. So, if pathogenic microorganisms have penetrated the human genitourinary tract, leukocytes will also get there from the bloodstream through the capillary wall. Upon encountering a foreign flora, phagocytosis begins. During it, leukocytes neutralize pathogenic microorganisms. If there are too many foreign bacteria, leukocytes die. The result is local inflammation. If the infection is not stopped, the number of dead leukocytes increases. As a result, pus is formed.

Normally, leukocytes may be present in a smear for flora. However, their number should not be too large. A slight excess of the norm can occur for physiological reasons. If there is a significant deviation in the number of leukocytes in the smear from the norm, and there are signs of phagocytosis, this indicates the presence of an infection that could be provoked by various types of pathogens.

smear on flora

It can be performed as one of the elements of a preventive examination, or prescribed if you suspect the presence of gynecological diseases. Indications for passing the analysis are:

• presence;
• failures in the menstrual cycle are observed;
• a woman experiences discomfort during intercourse;
• observed pathological discharge from the vagina;
• the woman is pregnant;
• there is itching and burning during urination;
• a woman is forced to take antibiotics, hormonal drugs and other drugs for a long period of time.

Many pathologies in the early stages are asymptomatic. In order to identify them in advance, it is recommended to take a smear every three months. The material is taken from the walls of the vagina, cervix or urethra. For the procedure, a disposable spatula is used. The process does not take much time. It is not associated with pain. The smear collection causes discomfort only in case of damage to the walls of the urethra. This is possible if there is an infection or inflammatory process.

To take a smear, you need to prepare. It must be taken into account that a number of factors can lead to distortion of the results. Therefore, experts recommend giving up sexual intimacy 3 days before a visit to the doctor. A week before the study, it is necessary to stop the use of drugs of any form. Soap and gel should not be used for hygiene of the external genital organs 2 days before the test. Only warm water is allowed. The last cleansing of the external genital organs is carried out the evening before visiting the doctor. Do not urinate 3 hours before the visit to the specialist.

Taking a smear during menstruation is not carried out. Exceptions are situations where an urgent diagnosis is necessary. The best time is considered the first days after menstruation or a moment shortly before its onset.

The rate of leukocytes in a smear in women (table)

When the smear is taken, it will be sent to the laboratory for analysis. Here, under a microscope, the number of leukocytes in the field of view will be counted. Normally, the value of the indicator should not exceed 15. In a healthy woman, white blood cells in a small amount are always present in the vagina. If an infection appears, they recognize foreign cells and begin to actively fight. This leads to an increase in the number of leukocytes.

It can be obtained from one of three points - the urethra, vagina or cervix. Depending on where the biomaterial was taken from, it may vary. It is:

• 0-10 if the swab was taken from the urethra;
• 0-15 if the swab was taken from the vagina;
• 0-30 if the smear was taken from the cervix.

In order to determine the condition of the woman, the doctor will pay attention to the presence of other microorganisms in the smear. So, chlamydia, gardnerella, yeast-like fungi, gonococci, atypical cells and Trichomonas should not be found in it. The result of the analysis can be found out very quickly. Usually the result of the study is known already on the day of taking a smear. Sometimes the deadline is shifted by two or three days.

During pregnancy

During pregnancy, changes occur in the functioning of the organs and systems of the female body. This is due to the fact that the hormonal balance is changing. There is an increase in the load on the kidneys. The microflora of the vagina also undergoes changes.

During the bearing of a child, a smear is taken from a woman several times. Initially, the action is carried out at registration. Normally, the number of leukocytes in pregnant women is 15-20. Exceeding the value of the indicator may indicate an acute pathological process or the course of latent infections that have become aggravated as a result of bearing a child. Most often, this phenomenon is provoked by sexually transmitted diseases, or. With an increase in leukocytes, additional diagnostic studies are prescribed, on the basis of which treatment is selected.

Before and after menstruation

The period before and after menstruation is considered the most favorable for taking a smear on the flora. During this period of time, a change in the number of white blood cells can be observed. Experts attribute this phenomenon to the presence of latent STIs in the body. Only in one percent of cases such changes are natural. The number of leukocytes before menstruation can be 35-40 if the smear was taken from the vagina, up to 10 if the swab was taken from the urethra, up to 30 if the material was taken from the cervix.

If a flora smear is taken immediately after menstruation, there is a significant deviation of white blood cells from the standard. The difference can be 1-3 units. This is due to the fact that in the first 2-3 days after menstruation, the uterus has not yet been completely cleansed.

If a woman does not adhere to the rules of personal hygiene during menstruation or uses tampons illiterately, the number of leukocytes can increase significantly. However, the value of the indicator usually normalizes within a few days if hygiene is normalized.

Possible causes of an increase in leukocytes

If the number of leukocytes in a smear is greatly increased, this indicates the development of a disease or pathologies of the internal organs. The number of white blood cells increases with the following diseases:

• inflammation of the vagina, appendages, uterine mucosa, urethra or cervical canal;
• the appearance of dysbacteriosis of the vagina or intestines;
• the occurrence of hormonal imbalance;
• the presence of sexually transmitted diseases;
• the presence of benign and malignant neoplasms in the genitourinary system;
• development of systemic diseases.

Frequent stress, long-term medication, and chronic overwork can also provoke an increase in the number of leukocytes in a smear. Sometimes a similar phenomenon causes an active sexual life. In this situation, the number of leukocytes can increase to 25 cells.

There are a number of signs that make it possible to suspect an increase in the level of leukocytes and the development of an inflammatory process in the urinary system. Symptoms of the onset of the disease are:

• problems with conceiving a child;
• the appearance of secretions of an unusual nature;
• during urination, a woman experiences pain;
• during intercourse, the patient experiences discomfort;
• there are false urges to urinate;
• secretions from the genitals have a pungent odor;
• there is a failure of the menstrual cycle.

It should be borne in mind that at the initial stage, the inflammatory process may not be accompanied by severe symptoms.

Ignoring an increase in the level of leukocytes in a smear can lead to a complication of the diseases that provoked such a phenomenon. Lack of treatment often leads to the transition of pathology to the chronic stage. Sometimes the disease can begin to progress, affecting the urinary system and kidneys. The hormonal balance of the body is disturbed. Against the background of diseases, the appearance of benign and malignant tumors is possible. A woman can develop ovarian dysfunction and even infertility. If the pathologies present are ignored by a woman who is expecting a child, this can lead to a miscarriage or pregnancy fading.

If the number of leukocytes is reduced

A decrease in the number of leukocytes or their complete absence in a smear is not considered a deviation from the norm. If a woman does not use an intrauterine device to protect against an unplanned pregnancy, adheres to the rules of hygiene and does not have a sexual life, white blood cells will not be detected during the analysis. However, there are other factors that lead to a general decrease in the number of leukocytes. A decrease in the level of these cells in the vaginal flora may indicate the presence of:

• diseases of a viral nature;
• general depletion of the body;
• diseases of the gastrointestinal tract;
• pathologies of the endocrine system.

Diagnosis and treatment

If a woman has an increase in the number of leukocytes in a smear, it is necessary to establish the cause that provoked this phenomenon. Usually, an increase in the number of white blood cells is accompanied by an increase in opportunistic microflora, which makes it possible to immediately suspect a particular disease. However, in practice, only leukocytes can increase, and specific pathogens are absent. In this situation, the gynecologist will refer the woman to re-smear, choosing the most successful day of the menstrual cycle and recommending to properly prepare for the test. If an increase in the number of white blood cells is observed in the second smear, an extended examination is performed. Can be done:

1. PCR for sexual infections. The method allows you to identify hidden diseases that may not manifest themselves clinically, but can lead to infertility.
2. Colposcopy. The study is an examination of the cervix under multiple magnification. The method allows to detect leukoplakia, dysplasia or oncological diseases at the initial stage.
3. Ultrasound of the pelvic organs. Various tumor formations can provoke an increase in the number of leukocytes, which can be diagnosed using ultrasound.

Based on the data obtained, the doctor can refer the patient to related specialists. So, if a woman has overweight, a disease, or, an endocrinologist will need to be consulted. If diseases of the urinary system are detected, they are referred to a nephrologist. Consultation with an allergist is required if there is a suspicion of an increase in the number of leukocytes as a result of exposure to various irritating factors. If neurosis became the reason for the deviation from the norm, the treatment is prescribed by a neurologist.

Therapy directly depends on the cause that provoked an increase in the number of leukocytes. Most often, their growth occurs as a result of inflammation. In this situation, local or general treatment can be carried out. The first category includes therapeutic douching. The course is short. Its duration usually does not exceed 4-5 days. Additionally, the doctor may prescribe the use of candles. Then the normal microflora of the vagina is restored. If the patient has infections or sexually transmitted diseases, antiviral drugs or antibiotic therapy are prescribed.

At each visit to the gynecologist during the examination, tests are necessarily taken from the urogenital tract, regardless of whether the woman has complaints or not. A smear on the flora displays not only beneficial, opportunistic and pathogenic bacteria, but also leukocytes.

Often, it is the elevated leukocytes in a smear in women that indicate some kind of malfunction in the body, it requires finding out the cause of this condition, and, of course, treatment. It is important to remember that no self-treatment will help to cope with the problem, and sometimes it can lead to negative consequences.

Briefly about leukocytes

Leukocytes are white blood cells that protect the body from all types of harmful agents (bacteria, viruses, etc.). That is, the main function of leukocytes is the implementation of the protection of the body, both specific, for example, from a certain type of microorganisms, and nonspecific or general.

The concentration of leukocytes increases in areas of inflammation, where they capture and digest foreign agents. In the case of a large accumulation of pathogenic agents, white blood cells increase significantly in size and begin to break down. The process of destruction of leukocytes is accompanied by a local inflammatory reaction: edema and hyperemia of the damaged area, an increase in local temperature.

smear on flora

A swab for flora, as already mentioned, is taken from a woman at every visit to the antenatal clinic, that is, every six months, if the patient has complaints, and also after a long course of antibiotics, when planning pregnancy, during gestation and after childbirth. During pregnancy, a smear for microflora (in the absence of complaints) is examined three times: upon registration, before maternity leave (30 weeks) and at 36 weeks.

Preparation for the delivery of the analysis

In order for the results of a smear on the flora to be reliable, it is necessary to prepare in advance for the test:

• for 1 - 2 days to exclude sexual contact;
• douching is not allowed 2 days before the visit to the doctor;
• it is forbidden to use candles, tablets and creams at least a day in advance;
• a smear is not taken during menstruation, since menstruation changes the composition of the smear;
• 2-3 hours before visiting the gynecologist, refrain from urinating;
• should be washed on the eve of the reception, with warm water without soap.

If a woman is preparing for a preventive examination, then it is advisable to schedule a visit to the gynecologist in the first days after menstruation or before they begin.

Sampling and testing procedure

In a gynecological smear, the composition of the microflora of the contents of the urethra, vagina and cervix is ​​determined.

The material is taken with sterile disposable instruments. A swab is taken from the urethra with a bacteriological loop or a Volkmann spoon, from the vagina (posterior fornix) with a sterile gauze swab, and from the cervix with an Eyre spatula.

Symbols are indicated on the slides:

• U - smear taken from the urethra;
• C - smear from the cervix;
• V - smear from the vagina.

After the glasses are dry, they are sent to the laboratory for analysis. Laboratory assistants stain smears with special dyes (according to Gram), then examine them under a microscope. During the analysis, leukocytes and various opportunistic and pathogenic bacteria are counted, which are stained in different colors.

Deciphering smear analysis

The data that is indicated in the smear analysis:

Leukocytes

The rate of leukocytes depends on the place from which the smear was taken. Their content is normally small. In the urethra, the number of leukocytes is 0 - 5 - 10, in the vagina their concentration corresponds to 0 - 10 - 15, and in the cervical canal from 0 to 30.

During pregnancy, the content of leukocytes increases slightly and can range from 15 to 20 (in the vagina) in the field of view.

squamous epithelium

The squamous epithelium lines the vagina, urethra and cervical canal. In normal smears, the number of epithelial cells ranges from 5 to 10. With the disappearance of the epithelium (0 cells in the field of view), they speak of atrophy of the mucous membrane, and in the case of an increase in epithelial cells, inflammation.

Slime

Lactobacilli or Doderlein sticks

Normal smears are characterized by a large content of them in the vagina, while they are absent in the cervix and urethra. With a decrease in the number of lactic acid bacteria, they speak of.

Yeast

Mushrooms of the genus Candida are normally absent at all three points of swab sampling, but their single presence in the vagina is allowed. An increase in yeast-like fungi indicates thrush.

"Key" cells

They are conglomerates of squamous epithelial cells and bacteria - gardnerella. Normally absent, the presence of such cells is a sign of gardnerellosis or bacterial vaginosis.

Leptothrix

Refers to anaerobic (living without air) gram-negative bacteria, often found in mixed infections, such as thrush and bacterial vaginosis or trichomoniasis and chlamydia. If these bacteria are detected in a smear, an extended analysis for sexual infections is indicated.

Other

• Mobilunkus - also refers to anaerobic microorganisms and is present in candidiasis or bacterial vaginosis.
• Trichomonas - refers to the simplest, normally they are absent in the smear.
• Gonococci - cause a sexually transmitted disease - gonorrhea, respectively, are normally absent.
• coli- normally observed in a single number in a smear from the vagina. With an increase in the concentration of bacteria, bacterial vaginosis and neglect of personal hygiene are possible.
• Cocci - in gynecological smears are divided into gram-positive - stained blue and gram-negative - do not stain and remain pink. Gram-positive cocci include opportunistic bacteria: streptococci, staphylococci and enterococci, which are normally contained in smears in single quantities. With an increase in their concentration, they speak of nonspecific vaginitis (colpitis).

Degrees of purity of the vaginal smear

When talking about gynecological smears, they mean not only smears taken from the cervical canal, urethra and vagina, but also a separate type of smear that determines the degree of cleanliness of the vagina. The material is taken from the walls of the vagina and dried on a separate glass. There are 4 degrees of purity, but only degrees 1 and 2 are normal:

• 1 degree - leukocytes 0 - 5

Considered ideal. The number of leukocytes is small, the microflora is mainly (up to 95%) represented by lactic acid bacteria, epithelial cells are few.

• 2 degree - leukocytes 5 - 10

It also refers to the norm, but in a smear opportunistic microorganisms (cocci or single yeast fungi) are determined in a small amount. Lactobacilli prevail, leukocytes and mucus are moderate, epithelial cells are normal.

• 3 degree - more than 10 (up to 50)

The content of leukocytes increases, a lot of mucus and epithelium is determined. The concentration of Doderlein sticks decreases due to an increase in opportunistic flora.

• 4 degree - leukocytes completely (not countable)

Against the background of a huge number of leukocytes (the term “completely” is indicated in the description of the smear), pathogenic microorganisms (gonococci, Trichomonas) are determined. Doderlein's sticks are not determined, there are a lot of mucus and epithelial cells (a consequence of the inflammatory process).

When identifying 3 and 4 degrees of purity of the vaginal smear, it is necessary to establish the cause of the inflammation and treat it.

Causes of an increase in the content of leukocytes in a smear

If the leukocytes in a smear in women are increased, then the causes can be both diseases of the reproductive sphere, and malfunctions in the work of other internal organs and systems. Inflammation comes first among the causes of an increase in leukocytes in urogenital smears:

• inflammatory process in the cervical canal or;
• development of inflammation in the appendages (tubes and ovaries) or salpingo-oophoritis;
• inflammation of the uterine mucosa - endometritis;
• inflammatory process in the vagina - colpitis or vaginitis;
• the development of inflammation in the urethra - urethritis;
• malignant tumors of the genital organs (destruction of healthy tissues is accompanied by inflammation);
• intestinal and/or vaginal dysbacteriosis;
• infections that are sexually transmitted (both sexually transmitted diseases and latent sexual infections).

Pathogenic microorganisms - the culprits of inflammation

Why do leukocytes increase in a smear? Pathogenic microorganisms are involved in the development of the inflammatory process, which are difficult to detect in the usual way - by examining a urogenital smear, or activated representatives of the opportunistic flora. To detect pathogens of latent sexual infections, they resort to a more complex examination - the PCR method (examination of blood, urine, secretions from the genital organs).

With a detailed study in smears or blood, the following can be detected:

• mycoplasma and ureaplasma;
• gonococci (see);
• Koch's stick (the causative agent of tuberculosis);
• pale treponema (pathogen);
• Donovan bodies (causative agents of inguinal granuloma);
• trichomonas (see);
• amoeba;
• human papillomavirus (cause);
• immunodeficiency virus;
• viruses;
• mushrooms of the genus Candida ();
• actinomycete fungi.

Other causes of an increase in white blood cells

Bacterial vaginosis or vaginal dysbiosis

Under certain conditions, conditionally pathogenic flora is activated and the growth of lactic acid bacteria is suppressed:

• disruptions in hormonal status (puberty or decline in reproductive function - pre- and menopause, pregnancy and spontaneous abortion, endocrine diseases);
• weakening of local and general immunity (hypothermia, antibiotic therapy);
• severe stress and overwork;
• microtrauma of the vagina due to intense sex;
• radiotherapy, chemotherapy;
• the use of spermicides in the form of ointments and suppositories;
• oral sex;
• a large number of sexual partners;
• excessive adherence to the rules of intimate hygiene, passion for douching;
• the entrance to the vagina deformed by scars (anatomical features, pathological childbirth, surgical interventions);
• imbalance of the intestinal microflora (dysbacteriosis);
• foreign bodies in the vagina (tampons).

Allergy

• allergies to drugs and herbs;
• intolerance to lubricants (gels, ointments);
• partner's sperm intolerance.

Irritation of the vulva and vagina

• neglect of intimate hygiene;
• temperature changes (hypothermia and overheating);
• mechanical injury (tight, synthetic underwear, thongs, rough sex, etc.);
• chemical burns (douching with acids and other drugs);
• common diseases (diabetes mellitus, pathology of the urinary system and others).

In addition, elevated leukocytes in urogenital smears can be observed within 24 hours after intercourse or for 7 to 10 days after the installation of an intrauterine device. If the cause of the increase in the content of leukocytes in smears cannot be established, a more thorough and detailed examination should be carried out, including for the detection of malignant tumors of the reproductive system.

Causes of an increase in leukocytes in pregnant women

Some increase in the level of leukocytes in a smear during pregnancy is considered normal. The normal content of white blood cells in vaginal smears corresponds to 15 - 20 per field of view.

Elevated leukocytes in pregnant women in a smear are explained by physiological factors:

• Firstly, during the period of gestation, the hormonal balance is restructured, progesterone and estrogens are produced in large quantities. Under the influence of estrogens, Doderlein sticks begin to actively multiply, which create an acidic environment in the vagina and prevent the reproduction of opportunistic and pathogenic flora, but contribute to the accumulation of leukocytes.
• Secondly, expectant mothers have reduced immunity, which prevents the rejection of the embryo as a foreign body. Due to weakened immunity, pathogenic bacteria easily penetrate the vagina or a latent infection is activated, which explains the increase in leukocytes in gynecological smears (a protective reaction during inflammation).

Often a very high concentration of white blood cells in smears (50 - 100 or leukocytes entirely in the field of view) is detected, which, as a rule, is noted with thrush (urogenital candidiasis). In such cases, in addition to a large number of leukocytes, fungi of the genus Candida and mycelium in the form of white threads are found in the smear.

An excess of white blood cells in expectant mothers requires a thorough examination and appropriate treatment. The infectious process from the vagina can go to the cervix and cervical canal, penetrate the uterine cavity, which will lead to infection of the amniotic fluid and the fetus and end in miscarriage or premature birth.

Clinical manifestations

An increased level of leukocytes in secretions from the cervical and urethra and vagina often accompanies diseases of the urinary and reproductive organs of a woman:

• frequent and painful urination - a sign or;
• false urge to defecate indicate intestinal dysbacteriosis;
• discharge with an unpleasant odor, accompanied by itching and burning, may indicate vaginitis, cervicitis, or inflammation of the uterus and;
• purulent, foamy discharge or cheesy discharge are observed with vaginitis of a specific etiology (thrush, gonorrhea, trichomoniasis);
• possible with pathology of the cervix, uterus or appendages;
• in combination with an increase in leukocytes, it makes one think of inflammation of the appendages.

Diagnosis that determines the direction of treatment

Before you begin to deal with an increased level of white blood cells in smears, it is necessary to establish the cause of this phenomenon. It often happens that the content of leukocytes in a gynecological smear is high, although there is no activation and growth of opportunistic flora and, moreover, specific pathogens. What to do in such a case?

The gynecologist will recommend taking smears again, choosing the most successful day of the menstrual cycle and recommending that you properly prepare for the test (exclude sexual intercourse, taking medication, douching). If, upon re-smearing, leukocytes again have a high rate, an extended examination is performed:

A smear from the cervical canal and vagina on the tank. sowing

When sowing vaginal and cervical secretions on nutrient media, colonies of pathogenic and opportunistic microorganisms often grow. The pathogen is identified and its sensitivity to certain antibiotics is determined, which is necessary for further treatment.

PCR for latent sexually transmitted infections

The method is highly accurate and almost 100% reveals latent sexual infections, which may not manifest themselves clinically, but lead to irreversible consequences (infertility).

Ultrasound of the pelvic organs

In this case, preference is given to ultrasound performed by a transvaginal sensor. A possible cause of elevated leukocytes in the analyzes, in addition to inflammation of the uterus and appendages, can be various tumor-like formations (ovarian cysts, uterine fibroids or sarcoma, uterine polyps, etc.).

Colposcopy

Examination of the cervix under multiple magnification helps to diagnose diseases that are not visible to the naked eye, but are the cause of elevated leukocytes in the tests (leukoplakia, cervical dysplasia or cancer in the initial stage).

Consultations of related specialists

Appointed after the above examination. For example, consulting an endocrinologist and prescribing appropriate therapy to them will help normalize the level of leukocytes in diabetes mellitus, thyroid pathology, or overweight. A nephrologist will identify a disease of the urinary system (pyelonephritis, cystitis) and prescribe anti-inflammatory therapy (antibiotics, nitrofurans). The allergist will advise you to exclude irritating factors (synthetic underwear, the use of intimate sprays, deodorants and various lubricants). The neurologist will prescribe sedatives and drugs to eliminate neurosis, which can also cause an increase in leukocytes.

Anti-inflammatory treatment

Anti-inflammatory treatment is prescribed only if an infection is detected. How to treat, the doctor decides, depending on the results of the tests. Anti-inflammatory therapy includes:

• local treatment;
• general treatment;
• restoration of normal microflora of the vagina.

Local treatment consists in the appointment of douching:

• the course is short and lasts no more than 4 - 5 days
• drugs (solutions of potassium permanganate, chlorhexidine, miramistin)
• herbs (chamomile, sage, coltsfoot, calendula, St. John's wort). Cm. .

Candles:

• at the same time, candles with anti-inflammatory action are locally prescribed (hexicon, polygynax, betadine and others, see).
• if a diagnosis of urogenital candidiasis is made, it is recommended to use suppositories with an antifungal effect (clotrimazole, pimafucin, livarol, see). Suppositories are administered one to two times a day for 10 to 14 days.
• with an unstarted inflammatory process, treatment is limited to this.

Treatment of latent genital infections

If a viral infection, sexually transmitted diseases or latent genital infections are detected, systemic antibiotic therapy or antiviral drugs are prescribed. The choice of drug depends on the etiology of colpitis and / or cervicitis.

Restoration of the microflora

The final stage of therapy is the restoration of the normal microflora of the vagina (an increase in the content of lactic acid bacteria). For this purpose, the following are assigned:

• vaginal suppositories or tampons with probiotics (lactobacterin, bifidobacterin, acylact, colibacterin and others).

  A high content of white blood cells in smears during pregnancy is dangerous for premature termination of pregnancy (miscarriage or premature birth), intrauterine infection of the fetus, development of chorioamnionitis (inflammation of the water and placenta), rupture of the birth canal during childbirth and the development of purulent-septic diseases in the postpartum period. Therefore, expectant mothers should carefully follow the recommendations of the doctor and carry out the prescribed or treatment with an increase in the content of leukocytes in the analyzes.

  Question:
  Is it possible to have sex with elevated leukocytes in smear tests?

  If a specific infection is not detected (gonorrhea, chlamydia, genital herpes and other diseases), then sex is not contraindicated.

  Question:
  Can I get pregnant with elevated leukocytes in smears?

  Yes, it is quite possible to get pregnant, but it is advisable to undergo preliminary treatment, since often a high white blood cell count in the analyzes indicates an inflammatory process in the genitals.

  Question:
  Is it possible to reduce the content of leukocytes in the analyzes using only traditional methods of treatment?

  You should not engage in self-medication, including treatment only with traditional medicine with a “bad” result of a smear analysis. Only a doctor can identify the cause of "bad smears" and prescribe the appropriate treatment. It is impossible to reduce leukocytes in tests only with the help of traditional medicine, since it is often necessary to treat with antibiotics or antiviral drugs, or to treat concomitant diseases.