Update: October 2018 Each time a gynecologist visits during
examination must be taken from the urogenital analysis
тракта независимо от того, есть у of womenы жалобы или нет. AT мазке
the flora displays not only beneficial, opportunistic and
pathogenic bacteria, but also leukocytes.
Зачастую именно повышенные лейкоциты в мазке у of women
indicate any malfunction in the body, requires
finding out the cause of this condition, and, of course, treatment. ATажно
remember that no self-medication will help to cope with the problem,
and sometimes it can lead to negative consequences.
White blood cells are called white blood cells, which
protect the body from all kinds of harmful agents
(bacteria, viruses and other). That is the main function of leukocytes –
the implementation of the protection of the organism as specific, for example, from
a certain type of microorganism, and non-specific or
The concentration of leukocytes increases in places of inflammation, where they
capture and digest alien agents. AT случае большого
patches of pathogenic white blood cells significantly
increase in size and begin to collapse. Destruction process
leukocytes accompanied by a local inflammatory reaction: edema and
hyperemia of the damaged area, an increase in local
Smear on the flora
Smear on the flora, как уже указывалось, берется у of womenы при
every visit to the antenatal clinic, that is, every six months, with
the presence of complaints in the patient, as well as after a long course
antibiotics, when planning pregnancy, during gestation
fetus and after childbirth. ATо время беременности мазок на микрофлору (при
absence of complaints) is investigated three times: when registering, before
maternity leave (30 weeks) and at 36 weeks.
Preparation for the analysis
That results of smear on flora were reliable,
It is necessary to prepare in advance for the analysis:
- for 1 – 2 days to exclude sex;
- not allowed douching 2 days before the visit to the doctor;
- do not use candles, tablets and creams as
at least one day;
- smear is not taken during menstruation, since the monthly
change the composition of the smear;
- 2 – 3 hours before visiting the gynecologist to refrain from
- It should be washed on the eve of the reception with warm water without
Если of womenа готовится к профилактическому осмотру, то
It is advisable to make a visit to the gynecologist in the first days after
monthly or before they start.
The procedure of sampling and research material
AT гинекологическом мазке определяют состав микрофлоры
contents of the urethra, vagina and cervix
The material is taken
sterile disposable instruments. Smear from urethra is taken
bacteriological loop or Folkman’s spoon, from a vagina
(posterior vault) with a sterile gauze pad, and from the cervix
Legend on the slides:
- U – smear taken from the urethra;
- C – cervical smear;
- V – a vaginal smear.
After the glass is dry, they are sent to the laboratory for
study. Laboratory workers paint smears with special dyes
(Gram), then examine them under a microscope. AT процессе
analysis, leukocytes and various opportunistic and
pathogenic bacteria that are stained in different colors.
Interpretation of smear analysis
Data that is specified in the smear analysis:
White blood cells
The rate of leukocytes depends on the place from which it was taken
smear. Their content is normal small. AT уретре количество
leukocyte count is 0 – 5 – 10, their concentration in the vagina
corresponds to 0 – 10 – 15, and in the cervical canal from 0 to 30.
AT период беременности содержание лейкоцитов несколько повышается
and can range from 15 to 20 (in the vagina) in sight.
The flat epithelium is lined with the vagina, urethra and
cervical canal. AT нормальных мазках количество эпителиальных
cells ranges from 5 to 10. With the disappearance of the epithelium (0 cells in
visual field) talk about atrophy of the mucous membrane, and in the case of
an increase in epithelial cells is about inflammation.
A moderate amount of mucus is considered normal.
all three points, but in the urethra it may be absent.
Lactobacilli or Doderlein sticks
For нормальных мазков характерно большое содержание их во
влагалище, тогда как в цервиксе и уретре они are missing. With
reducing the number of lactic acid bacteria talk about bacterial
Candida fungi are normally absent at all three points.
sampling of swabs, but their single presence is allowed
vagina. An increase in yeast-like mushrooms suggests
They are conglomerates of squamous cells and
bacteria – gardnerell. AT норме отсутствуют, наличие подобных клеток
sign of gardnerella or bacterial vaginosis.
Refers to anaerobic (living without air) gram-negative
bacteria are often found when mixed infections,
for example, thrush and bacterial vaginosis or trichomoniasis and
chlamydia When detecting these bacteria in a smear shown
conducting an advanced analysis of genital infections.
- Mobilunkus – also refers to anaerobic microorganisms and
present in candidiasis or bacterial vaginosis.
- Trichomonas – refers to the simplest, normally in a smear, they
- Gonococci – cause a venereal disease – gonorrhea,
соответственно, в норме are missing.
- E. coli – normally observed in a single number in
vaginal smear. By increasing the concentration of bacteria is possible
bacterial vaginosis and neglect of personal hygiene.
- Cocci – in gynecological smears are divided into
gram-positive – blue colored and gram-negative –
not colored and remain pink. To gram-positive cocci
conditionally pathogenic bacteria are: streptococci, staphylococcus and
enterococci normally found in single swabs
quantities. With increasing their concentration they talk about
non-specific vaginitis (colpitis).
Vaginal smear purity
When talking about gynecological smears, it is not meant
only smears taken from the cervical canal, urethra
and vagina, but also a separate type of smear, which determines the degree
purity of the vagina. Material is taken from the vaginal walls.
and dried on a separate glass. There are 4 degrees of purity, but
Only grade 1 and 2 are normal:
- 1 degree – leukocytes 0 – 5
It is considered an ideal option. The number of leukocytes is small,
microflora is mainly (up to 95%) represented by lactic acid
bacteria, epithelial cell units.
- Grade 2 – leukocytes 5 – 10
Also applies to the norm, but in a smear is determined in a small
the number of conditionally pathogenic microorganisms (cocci or single
yeast mushrooms). Lactobacilli prevail, leukocytes and mucus –
moderately, epithelial cells are normal.
- 3 degree – more than 10 (up to 50)
The content of leukocytes increases, a lot of mucus is detected and
epithelium. The concentration of Doderlein sticks decreases due to
increase in conditionally pathogenic flora.
- Grade 4 – leukocytes completely (can not be counted)
Against the background of a huge number of leukocytes (in the description of a smear
the term “completely” is indicated) pathogenic microorganisms are defined
(gonococci, trichomonads). Doderlein sticks are not detectable, mucus
and many epithelial cells (a consequence of inflammatory
When identifying 3 and 4 degrees of purity vaginal smear
it is necessary to establish the cause of the inflammation and treat it.
Causes of increased white blood cell count in a smear
If the white blood cells in the smear are elevated in women, then the causes may
to be both diseases of the reproductive sphere and malfunctions
other internal organs and systems. First place among the reasons
increases in white blood cells in urogenital smears coming out
- inflammatory process in the cervical canal or cervicitis;
- development of inflammation in the appendages (tubes and ovaries) or
- inflammation of the uterine lining – endometritis;
- inflammatory process in the vagina – colpitis or vaginitis;
- development of inflammation in the urethra – urethritis;
- malignant tumors of the genital organs (destruction
healthy tissue is accompanied by inflammation);
- intestinal and / or vaginal dysbacteriosis;
- sexually transmitted infections (like venereal
diseases and hidden genital infections).
Pathogens – the culprits of inflammation
Why do white blood cells increase in a smear? In the development of inflammatory
The process involves pathogens that are difficult
detect in the usual way – the study of urogenital smear,
or intensified representatives of the conditionally pathogenic flora. For
detection of pathogens of hidden genital infections have resorted to more
complex examination – the method of PCR (blood test, urine,
discharge from the genitals).
With a comprehensive study in smears or blood can be
- mycoplasmas and ureaplasmas;
- gonococci (see symptoms of gonorrhea);
- Koch’s wand (causative agent of tuberculosis);
- Treponema pallidum (causative agent of syphilis);
- Donovan’s corpuscles (pathogens of inguinal granulomas);
- trichomonas (see symptoms of trichomoniasis);
- human papillomavirus (a cause of cervical cancer);
- immunodeficiency virus;
- genital herpes viruses;
- fungi of the genus Candida (thrush);
- actinomycete fungi.
Other causes of increased white blood cell count
Bacterial vaginosis or vaginal dysbiosis
Under certain conditions, conditionally pathogenic activates.
flora and inhibited the growth of lactic acid bacteria:
- disruptions in hormonal status (puberty or extinction
reproductive function – pre- and menopause, pregnancy and
spontaneous abortion, endocrine diseases);
- weakening of local and general immunity (hypothermia,
- severe stress and overwork;
- vaginal microtraumas due to intense sex;
- radiation therapy, chemotherapy;
- the use of spermicides in the form of ointments and candles;
- oral sex;
- a large number of genital partners;
- excessive adherence to intimate hygiene rules
- scarred deformed entrance to the vagina (anatomical
features, pathological labor, surgical
- imbalance of intestinal microflora (dysbacteriosis);
- foreign bodies in the vagina (tampons).
- allergies to drugs and herbs;
- intolerance lubricants (gels, ointments);
- sperm intolerance partner.
Irritation of the vulva and vagina
- neglect of intimate hygiene;
- temperature drops (overcooling and overheating);
- mechanical injury (cramped, synthetic underwear,
thongs, rough sex, etc.);
- chemical burns (douching with acids and other
- common diseases (diabetes mellitus, urinary pathology
systems and others).
In addition, elevated leukocytes in urogenital smears can
be observed within 24 hours after coitus or for 7 –
10 days after the installation of the intrauterine device. If the reason
it is not possible to establish an increase in the content of leukocytes in smears,
a more thorough and detailed examination should be carried out, including
number and to detect malignant tumors
Causes of increased white blood cells in pregnant women
Some increase in leukocyte count in smear during pregnancy
considered normal. The normal content of white blood cells in
Vaginal smears correspond to 15 – 20 in sight.
Increased leukocytes in pregnant women in smear are explained
- First, in the period of gestation, restructuring occurs
hormonal balance, in large quantities produced
progesterone and estrogen. Under the influence of estrogen begins actively
breed Doderlein sticks that create an acidic environment during
vagina and prevent the conditionally pathogenic and
pathogenic flora, but contribute to the accumulation of leukocytes.
- Secondly, future mothers are reduced immunity, which warns
rejection of the embryo as a foreign body. Due to weakened
immunity penetrates into the vagina pathogenic bacteria or
latent infection is activated, which explains the increase in
leukocytes in gynecological smears (protective reaction during
Often detected very high concentrations of white blood
Taurus in smears (50 – 100 or leukocytes completely in sight), that
As a rule, it is noted for thrush (urogenital candidiasis). AT
such cases in a smear except a large number of leukocytes
fungi of the genus Candida and mycelium in the form of white threads are found.
Excess content of leukocytes in expectant mothers requires
thorough examination and appropriate treatment. Infectious
the process from the vagina can go to the cervix and the cervical canal,
penetrate the uterus, which will lead to infection
amniotic fluid and fetus and result in miscarriage or
Increased white blood cell count in cervical and
the urethra and vagina often accompanies
diseases of the urinary and reproductive systems
- frequent and painful urination is a sign of cystitis or
- false urge to defecate indicate dysbacteriosis
- discharge with an unpleasant smell, accompanied by itching and
a burning sensation may speak of vaginitis, cervicitis, or inflammation of the uterus and
inflammation of the appendages;
- purulent, frothy or cheesy discharge
observed with vaginitis of a specific etiology (thrush,
- pains during coitus are possible with pathology of the cervix uterus
- menstrual dysfunction combined with increased
leukocyte makes you think about inflammation of the appendages.
Diagnostics determining the direction of treatment
Before you begin to deal with elevated white blood levels
Taurus in brush strokes, it is necessary to establish the cause of this phenomenon.
It often happens that the content of white blood cells in gynecological
smear high, although there is no activation and growth of conditionally pathogenic flora
and, moreover, specific pathogens. What to do in a similar
The gynecologist will recommend resubmit strokes, picking up the most
Good day of the menstrual cycle and recommending correctly
prepare for tests (exclude sexual acts, reception
medication, douching). If at repeated delivery of smears leukocytes
again have a high rate, an extended
Smear from the cervical canal and vagina on the tank. sowing
With sowingе влагалищных и шеечных выделений на питательные среды
often grow colonies of pathogenic and conditionally pathogenic
microorganisms. Identification of the pathogen and
determined by its sensitivity to certain antibiotics that
need for further treatment.
PCR for hidden genital infections
Метод высокоточен и практически в 100% выявляет скрытые
genital infections that clinically can not manifest themselves, but
lead to irreversible effects (infertility).
Ultrasound of the pelvic organs
AT данном случае предпочтение отдается УЗИ, проведенному
transvaginal sensor. Possible cause of elevated leukocytes
in tests, in addition to inflammation of the uterus and appendages there may be various
tumor formations (ovarian cysts, uterine myoma or sarcoma,
uterine polyps, etc.).
Examination of the cervix under multiple magnification helps
diagnose diseases that are not visible to the naked eye,
but are the cause of increased leukocytes in analyzes (leukoplakia,
cervical dysplasia or cancer in the initial stage).
Consultations related professionals
Appointed after carrying out the above survey.
For example, an endocrinologist’s consultation and appointment
appropriate therapy will help normalize white blood cell count
in case of diabetes, thyroid gland or
overweight. Nephrologist will detect urinary disease
systems (pyelonephritis, cystitis) and prescribe anti-inflammatory
therapy (antibiotics, nitrofurans). Allergist advises to exclude
irritants (synthetic underwear, intimate use
sprays, deodorants and various lubricants). Neurologist appoint
sedative charges and drugs to eliminate neurosis which
can also cause an increase in leukocytes.
Anti-inflammatory treatment назначается только в случае
detection of infection. How to treat, the doctor decides, depending on
test results. Anti-inflammatory therapy includes:
- local treatment;
- general treatment;
- restoration of normal vaginal microflora.
Topical treatment is the appointment of douching:
- the course is short and lasts no more than 4 to 5 days
- drugs (potassium permanganate solutions,
- herbs (chamomile, sage, coltsfoot, calendula, St. John’s wort).
See how to do douching and whether it is needed.
- at the same time, locally assigned candles with anti-inflammatory
action (hexicon, polygynax, betadin and others, see all
anti-inflammatory candles in gynecology).
- if diagnosed with urogenital candidiasis is recommended
use candles with antifungal effect (clotrimazole,
pimafucin, livarol, see all candles from thrush). Introduce candles
once or twice a day for 10-14 days.
- if the inflammatory process is not started, treatment with this and
Treatment of hidden genital infections
In case of detection of viral infection, sexually transmitted diseases
or hidden genital infections are assigned systemic
antibiotic therapy or antiviral drugs. Selection
drug depends on the etiology of colpitis and / or
Recovery of microflora
The final stage of therapy is the restoration of normal
vaginal microflora (increase in lactic acid content
bacteria). For this purpose, appointed:
- vaginal suppositories or probiotic tampons (lactobacterin,
bifidobacterin, acylact, colibacterin and others).
- The course of treatment with probiotics is 2–4 long.
of the week.
ATопрос: Чем грозит высокое содержание лейкоцитов в
If a high level of white blood cells in the analyzes is due to
inflammatory process, the refusal of treatment is fraught with infertility,
ectopic pregnancy, the development of adhesive pelvic disease,
uterine myoma, endometriosis, menstrual disorders and even
the occurrence of malignant tumors of the genital organs.
ATопрос: Я беременна и сдала мазок, в котором
identified increased leukocytes. Why is this dangerous?
The high content of white blood cells in smears in the period
pregnancy is dangerous premature termination of pregnancy
(miscarriage or premature birth), intrauterine
infection of the fetus, the development of chorioamnionitis (inflammation of water and
placenta), ruptures of the birth canal during labor and development
purulent-septic diseases in the postpartum period. therefore
future mothers should with great care follow the recommendations
doctor and conduct prescribed or treated with increasing content
leukocytes in the analyzes.
ATопрос: Можно ли вести половую жизнь при
elevated leukocytes in smear tests?
If a specific infection is not detected (gonorrhea, chlamydia,
genital herpes and other diseases), then sex is not
ATопрос: Могу ли я забеременеть при повышенных
leukocytes in smears?
Yes, it is possible to get pregnant, but it is desirable to pass
pretreatment as often high
leukocytes in the analyzes speaks of the inflammatory process in the genital
ATопрос: Можно ли снизить содержание лейкоцитов в
analyzes, using only traditional methods of treatment?
Do not self-medicate, including treatment
only traditional medicine with a “bad” result of smear analysis.
Only a doctor can identify the cause of “bad smears” and prescribe
appropriate treatment. Reduce leukocytes in analyzes with only
using traditional medicine is impossible, as it is often necessary
antibiotic or antiviral treatment
or therapy of concomitant diseases.