What determines a smear at a gynecologist? What does a vaginal smear show?

The standard list of examinations for women when planning pregnancy includes a smear for microflora from the vagina. This analysis allows you to assess the state of the microflora of the vagina, cervix and urethra, as well as identify the presence of pathogenic bacteria and their sensitivity to antibacterial drugs. In this article we will look at how a smear is taken and what problems it helps to recognize.

A microflora smear allows you to recognize infectious and inflammatory processes in the genital organs.

In what situations is this analysis taken from women?

• preventive examination by a gynecologist once a year;
• if you experience itching, discomfort or discharge with an unpleasant odor from the vagina;
• during pregnancy it is performed several times to control the microflora of the genital tract;
• with frequent changes of sexual partners;
• after long-term use of antibacterial agents, hormonal drugs and drugs that reduce immunity.

What is the preparation for research?

Of course, you can take a smear without prior preparation, but to get the correct result you need to follow the recommendations of your gynecologist:

• do not have sex for several days before the smear;
• do not douche;
• do not use vaginal suppositories, creams and ointments for at least 2-3 days before taking the test;
• do not take a smear during menstrual bleeding;
• a smear is taken after the morning toilet of the external genitalia with plain water without the use of detergents, maximum simple soap;
• Before taking a smear, you should not urinate for 1-2 hours.

Important! Ideally, a smear in gynecology is taken 4-5 days after the end of menstruation, on days 3-5 of the cycle.

How does the smear procedure work?

Before taking the test, women worry about how the smear is taken and whether it hurts. There's really nothing special about it. The woman is in a gynecological chair, and the doctor uses a sterile swab or special instrument to collect contents from three zones:

• vaginal mucosa;
• cervical canal of the cervix;
• urethra (urethra).

This test is relatively painless. Some sensitive women may complain of mild discomfort, which is most likely due to psychological reasons.

A flora smear is a relatively painless procedure.

What should normally be in this smear?

In healthy women, the majority of microorganisms found in a vaginal smear are lactobacilli (lactobacillus). They are gram-positive lactic acid bacteria, which during their metabolism can produce lactic acid, lysozyme, hydrogen peroxide and other active substances.

The main function of lactobacilli in women is to maintain an acidic environment in the vagina and protect the genital tract from the penetration of pathogenic agents.

Important! When the number of these bacteria decreases, vaginal dysbiosis develops and other opportunistic microflora (Escherichia coli, staphylococci and streptococci) begin to multiply. This leads to the development of inflammatory diseases.

In addition, the vagina may normally contain small amounts of candida (fungi of the genus Candida) and gardnerella (bacteria). With normal immunity, the body inhibits the growth of these bacteria and fungi, but when the immune defense decreases, their number begins to grow, causing thrush (candidiasis) or gardnerellosis.

Deciphering a smear for flora in gynecology

A day or two after the smear, the woman receives a form with test results and struggles with identifying incomprehensible abbreviations and abbreviations. Let's look at what characteristics are present in a regular smear and what they mean.

The material is taken from three points, so on the form they can be designated by three Latin symbols V (vagina - vagina), C (cervix - cervix) and U (uretra - urethra) or simply signed.

Leukocytes(L) are normally observed in small quantities. During inflammatory processes, their number increases sharply.

Flat epithelium or just epithelium. An increase in the number of epithelial cells is also a marker of the inflammatory process.

Gonococci(Gn). Detection of gonococci indicates gonorrhea.

Trichomonas(Trich). The detection of trichomonas indicates trichomoniasis.

Slime Normally present in moderate amounts in the vagina and cervix. Its increase indicates an inflammatory or infectious process.

Norm and pathology of smears for microflora in gynecology.

Key cells- These are epithelial cells on which the gardnerella bacterium is found. An increase in their number indicates gardnerellosis.

Lactobacilli(Doderlein sticks) - normally found in large quantities in the vagina. Their decrease indicates dysbiosis.

Candida. Normally, a small amount of yeast-like fungi may be observed. If their number is increased, then thrush is diagnosed.

In addition to these basic parameters, the flora analysis can determine staphylococci and streptococci, E. coli and other microorganisms, an increase in the number of which indicates inflammation of the genital tract.

In some laboratories, the “+” sign is used to determine the number of certain parameters. What does it mean:

• a small amount - “+”;
• moderate amount - “++”;
• indicator increased - “+++”;
• a significant increase in the indicator - “++++”.

What does the degree of vaginal cleanliness indicate?

Based on the data obtained after the smear, the specialist makes a verdict on the degree of vaginal cleanliness:

• I – practically never found;
• II – the most common degree among healthy women;
• III – indicates an inflammatory process;
• IV – signals dysbacteriosis, vaginosis or sexually transmitted infections.

Questions for the doctor

Question: What additional tests will help identify why the number of lactobacilli in the smear is reduced.

Answer: Reduced levels of lactobacilli may be associated with inflammatory diseases. Additionally, tests for STIs and general clinical tests are prescribed.

Question: Staphylococcus was found in the smear. I read that it can be detected in a normal smear in women. The attending doctor said that this was a pathology. Which one of us is right?

Answer: Normally, women may have a small amount of staphylococci, when their level reaches 10 5 degrees - this is considered a pathology.

Microflora analysis is the first step towards diagnosing various diseases in gynecology. If deviations are detected, do not panic. It is necessary to repeat the tests taking into account the doctor’s recommendations or conduct additional research to find the source of the problem.

Women's examinations

The process of taking a smear

Gynecological examination of a smear is carried out today with modern devices (microscopes, etc.). Smear microscopy allows you to study in detail the microflora of the genital tract, determine the form of the disease, its severity, and also helps prescribe the necessary medications to promote recovery.

Female examinations should be carried out in sterile rooms, using disposable gynecological kits, in compliance with a regulated sequence of actions. Note that smears in gynecology are taken from the vagina, cervical or urethra, as well as from the rectum.

It is important not to damage the walls and tissues during the procedure. Otherwise, it may cause discomfort in the future or other diseases.

Let's take a step-by-step look at how smears are examined.

1. Insertion of a gynecological speculum. This stage is typical only for women who are sexually active.
2. Taking a smear using a spatula or spatula.
3. Applying material to a glass slide.
4. Sent to the laboratory for study.

After the material arrives at the laboratory, the specialist colors it, waits for it to dry completely, and only then begins to examine the gynecological smear. Using a microscope and staining, a laboratory technician can see various bacteria, fungi, infections, and determine their number and ratio. After conducting the research, the specialist writes down the results on a special form and passes them on to the attending physician.

Women's smears under a microscope, or rather, their results, will not take long to arrive - they arrive within one working day.

In turn, the leading gynecologist, based on the results of the analysis, writes down his final verdict and prescribes treatment. If there is any doubt about the correctness of the result, a repeat vaginal smear is prescribed.

Decoding the results

When you hold your results in your hands, the question involuntarily arises of what the smear at the gynecologist shows (the Latin letter and numbers next to it) and how to understand the encrypted results. Let's figure it out.

• Latin "V" - vagina. The adjacent numbers show the contents of the smear.
• The Latin "C" stands for "cervix". The numbers will tell the doctor about all the changes that can be observed in the area under study.
• The Latin "U" means "urethra". The meaning of the numbers is the same as for a cervical smear.
• Latin "L" - leukocytes.
• "Ep" - squamous epithelium.
• The line with “abs” indicates bacteria and infections that you have not detected.
• “gn” and “trich” - gonococci (the causative agent of gonorrhea) and the bacterium trichomoniasis, the causative agent of trichomoniasis.

For visualization, you can view an atlas of gynecological smears, which will allow both gynecologists and the patient to understand or better understand the diagnosis and possible pathologies. All atlases are illustrated and have detailed comments.

Norms of smears for flora

Flora smear analysis has its own standards, which can be found below. The norm is affected by age. So, for example, for girls under fourteen years old there are one indicators, for women after menopause - different. Therefore, the presented norms are typical for women aged 14 to 45-50 years.

• Leukocytes. (V) 0 - 10 in the field of view, (C) 0 - 30 in the field of view, (U) 0 - 5 in the field of view. In the case of an increased level of leukocytes, we can talk about inflammatory processes in a certain area.
• Epithelium. In all positions (V, C, U) it should be “moderate”. If the indicator increases, one should talk about inflammation, and a decreased level indicates a lack of estrogen (female sex hormone).
• Slime. In the case of (V) and (C) - “moderately”, and in the case of (U) - “moderately” or “absent”. A large amount of mucus indicates inflammation.
• Gram-positive rods (gr.+). (V) - “large amount”, (C) - “absent”, (U) - “absent”. Such results indicate good immunity and the normal state of the microflora.
• Gram-negative rods (gr.-). (V), (C), (U) - “absent everywhere.” The presence of rods indicates dysbiosis and inflammation.

Reminder for those planning to take a smear test

How to prepare for a flora smear and what you should not do before taking it should be remembered right now, because compliance with the rules and hygiene standards is the key to the correct and reliable result of the study and the subsequent prescription of treatment.

• A vaginal smear for flora involves stopping taking any vaginal medications for three days and abandoning all antibacterial agents.
• A smear for microflora in women or any other type of smear is not given during menstruation or 1-2 days after its end.
• Before the analysis (the night before and in the morning), it is forbidden to wash or douche.
• It is necessary to abstain from sexual intercourse.

A smear in gynecology is more than just a necessity, because such tests are vital. Timely detection of diseases is the key to fast and effective treatment. Therefore, do not neglect the rules, preventive methods and visit your gynecologist regularly.

Reading time: 6 min

A mandatory procedure when visiting a gynecologist is to take biological material to assess the condition of the microflora and epithelial cells of the vagina, the internal mucous membrane of the uterine body, endometrium, and cervical canal.

A gynecological smear, the examination and interpretation of which is carried out in a laboratory setting, is highly informative.

The analysis allows us to determine the hormonal level of the reproductive system, the amount and composition of vaginal discharge, the bacterial content of microflora in women, prevent inflammatory processes, identify developmental pathologies, the presence of neoplasms and infections that are sexually transmitted.

Diseases of the female reproductive system are dealt with by a specialized branch of medicine - gynecology.

There are many reasons for patients to apply: undergoing a medical examination for employment, pregnancy, painful or unpleasant cramping sensations in the lower abdomen, itching or burning, thrush, heavy menstruation or discharge of unknown origin.

A general smear or microscopy is performed during a preventive examination or during pregnancy planning. The result is the study of the cervical and urethral canal, vagina, and in virgins - the rectum.

Papanicolaou cytology analysis makes it possible to timely detect the papilloma virus, precancerous conditions of the epithelium, and cervix. It is recommended that all females with hereditary cancer diseases and those over 21 years of age undergo a Pap test.

A bacteriological research method, bacterial culture in women, is recommended if there is a suspicion of an inflammatory process, a disorder of the microflora, which was caused by opportunistic and pathogenic microorganisms.

PCR is carried out in the form of an analysis for infections transmitted mainly through sexual contact. Provides complete information about the bacterial composition of the internal microflora.

The effectiveness and reliability of the method is 98%.

Preparing for a smear test

Before prescribing an examination, the gynecologist or laboratory employee is obliged to warn the patient about how to properly take a smear for flora, what can and cannot be done before the procedure.

Preparation for a microscopic examination involves avoiding strong antibiotics 2 weeks before the expected analysis and visiting the bathroom the day before. You should try not to go to the toilet 2 hours before the test.

It is better to do diagnostics not before, but during menstruation and in the first two days after.

To increase the sensitivity of the test, microflora culture is carried out in the absence of treatment with antibacterial drugs and douching. Be sure to follow a special diet 2-3 days before the bacteriological analysis: limit foods that provoke fermentation or intestinal upset.

Refrain from sexual intercourse with your partner and do not wash yourself 24 hours before data collection.

3-5 days before the prescribed PCR diagnosis, taking any antibacterial and contraceptive drugs is prohibited. It is necessary to avoid sexual intercourse for 36 hours. It is advisable not to shower the day before the PCR and on the eve of the test. The material is taken during menstruation and for 1-2 days after its end.

How to take a smear from women

The technique for collecting material is usually carried out in the morning in the gynecology department or directly in the laboratory itself. Taking vaginal discharge and areas for examination is prescribed only for women who are sexually active. In girls, it is taken more carefully from the lateral vault of the vagina to prevent damage to the hymen, and from the intestines, secretion.

All manipulations take place on a gynecological chair. At this time, the specialist introduces a special mirror depending on the age and physiological characteristics of the patient. If the organs are not yet formed, size XS is used, girls will need a mirror S. After labor, examination instruments with a diameter of 25-30 mm, sizes M, L are used.

The material is collected with a spatula or spatula, brush, applied to a glass slide or placed in a test tube for further transfer of the results to the laboratory.

Microflora smear: interpretation

It is impossible to independently draw a conclusion about how good or bad a smear is without the appropriate knowledge. Using special notations, it is very easy to decipher a microscopic examination of a smear. Depending on the location of the biological material taken, they are distinguished: vagina - “V”, cervix - “C” and urethra - “U”.

Gram-positive rods, “Gr.+” and the absence of coccal flora. The result is “++++”. It is observed quite rarely, most often it is a consequence of intensive antibacterial therapy. Norm: “++”, “+++” rods, the number of cocci does not exceed “++”.

Gram-negative bacteria gonococci - “Gn”, trichomonas vaginalis - “Trich”, yeast of the genus “Candida”. Corresponds to diseases such as gonorrhea, trichomoniasis and candidiasis.

The presence of key cells and E. coli, if they are listed in the microflora, indicates that the patient has bacterial vaginosis.

Flora smear: normal in women

All patients, without exception, from the age of 14 until the onset of menopause, correspond to the same standard, obtained as a result of laboratory microscopic examination.

Leukocytes. Providing protection for the body from penetrating viruses, bacteria and infections, they can be in the field of view, but should not exceed the indicator in the vagina - 10, in the cervix - 30, urethra - 5.

Epithelium. A moderate amount of epithelial tissue is normal. A high number indicates possible inflammation, while a too low number indicates insufficient production of the hormone estrogen.

Slime. A small amount or no quantity is allowed. The maximum daily rate of secretion from the glands of the cervical canal is 5 ml.

Gram-positive rods, “Gr.+”. Lactobacilli and Doderlein bacilli must be present in large quantities. They are responsible for the body's immune response to foreign bodies. They should not be in the cervix and urethra.

“Gr.-”, gram-negative, anaerobic rods are not detected.

Gonococci with the symbol “gn”, Trichomonas, chlamydia, key and atypical cells, fungi, yeast, Candida are absent. If they are detected in the results, the patient is prescribed additional testing for gonorrhea, trichomoniasis, chlamydia, bacterial vaginosis, and thrush.

Smear for purity level

To avoid complications during pregnancy, pregnant women are advised to determine the degree of purity of the gynecological smear. Normally, in a healthy woman, 95-98% of the vaginal microflora consists of Bacillus vaginalis or Lactobacillus bacillus Doderlein. They produce lactic acid, which helps maintain acidity levels.

Pathogenic and opportunistic microorganisms are not able to survive in such conditions. But under the influence of various factors, such as sexual activity, menopause, the menstrual cycle and decreased immunity, microflora indicators can change.

• 1st degree Normal vaginal cleanliness is pH 3.8-4.5. The environment is acidic. Leukocytes and epithelial cells - no more than 10.
• 2nd degree. Slightly acidic environment: pH=4.5-5. There is a slight increase in gram-positive cocci and Candida fungi.
• 3rd degree. Pathogenic microorganisms are activated, mucus appears, and epithelial indicators exceed the norm. Neutral acidity level, pH=5-7. There are over 10 leukocytes. Mucus, key cells are present, gram-negative and gram-positive microorganisms multiply in favorable microflora conditions.
• On the last one, 4 degrees, cleanliness is low. pH values ​​reach 7.5. Doderlein's rods are either completely absent or found in single quantities. The vagina is filled with pathogens.

Bacteriological research

The variety of composition, in addition to Lactobacillus bacillus Doderlein, which is an integral part of the vaginal microflora of the woman being examined, does not begin to be studied immediately. Sowing the collected biological material onto a specially created favorable environment for its subsequent growth, development and reproduction takes time.

Bacteriological culture of flora can be assessed through a microscope, provided that the number of representatives of microorganisms increases.

• 0 class. Observed during treatment with antibiotics. The pathogen is absent.
• I class. The number of bacteria does not increase or increases moderately.
• II class. Mixed nature of microflora. Up to 10 colonies of bacteria Gardnerella vaginalis or Mobiluncus, the causative agents of gardnerellosis, are detected.
• III class. There are about 100 colonies. The microflora is predominantly inhabited by Gardnerella and Mobiluncus. Symptoms of bacterial vaginosis appear.
• IV class. Lactobacilli are absent, immunity is weakened. Diagnosis of acquired infectious disease - aerobic vaginitis.

Cytological examination

The probability of detecting areas of altered epithelium, papilloma virus and oncological tumors is quite high after 30 years of age and the beginning of sexual activity.

The correct interpretation of the PAP test depends on the presence or absence of cancerous, atypical cells.

• NILM. The clinical picture is without features, CBO. Leukocytes and bacteria are released in small quantities. Primary candidiasis or bacterial vaginosis is possible. The epithelial layer is normal.
• ASC-US. Atypical areas of unknown origin were found in epithelial tissue. A repeat analysis is carried out after 6 months to look for chlamydia, dysplasia, and human papillomavirus.
• LSIL. To confirm a precancerous condition caused by atypical cells, a biopsy and colposcopy are prescribed. Weak signs of changes in the epithelium.
• ASC-H. Pronounced damage to the squamous epithelium. 1% of patients are diagnosed with the initial stage of cervical cancer, the remaining 98-99% have grade 2-3 dysplasia.
• HSIL. Concomitant symptoms preceding cancer of the squamous epithelium and cervix were identified in more than 7% of the women examined. 2% have cancer.
• AGC. Atypical condition of the glandular epithelium. Diagnosis: cervical or endometrial cancer, advanced form of dysplasia.
• AIS. Squamous cell carcinoma, cervical cancer.

PCR analysis

The molecular biological method of PCR diagnostics is distinguished by its high sensitivity and reliability of the data obtained. By creating earlier samples of the isolated and copied DNA section, comparisons are made with the resulting biological material.

Testing for infections using PCR makes it possible to quickly find the causative agent of a disease in the female genital organs by obtaining a positive or negative result.

The polymerase chain reaction facilitates the determination of chlamydia, ureaplasmosis, thrush, trichomoniasis, HPV, HIV, and the search for the causes of difficult pregnancy and hormonal disorders.

The disadvantages of PCR are cases of false data due to incorrect tests and possible mutation of the pathogen's DNA.

By the purity you can judge the microflora, whether it is normal or pathogenic. There are 4 degrees in total, but only the first two are the norm.

Characteristic:

• I degree. It is rare. The environment is acidic, pH=4-4.5. Leukocytes, Dederlein bacilli and other indicators are within the normal range.
• II degree. The acidity of the vagina decreases, the pH increases to 5. This indicates that the flora is populated by a small number of pathogenic microorganisms. There is no inflammatory process, so leukocytes are not exceeded. The infection is at an early stage of development, so Candida and cocci fungi may appear.
• III degree. An increase in pathogenic microflora is detected, but the number of lactobacilli is significantly reduced. The vaginal environment becomes alkaline, pH = 5-7. Epithelial cells indicate inflammation.
• IV degree. The pH changes, it is 7-8. Leukocytes, mucus and other inclusions are much higher than normal. There are no lactobacilli, the flora is pathogenic.

Grades III and IV require treatment.

To assess the state of the microflora, the concept of “degree of vaginal cleanliness” is used.

1 degree of vaginal cleanliness

The first degree of vaginal cleanliness - this indicator indicates that the woman is completely healthy. The content of lactobacilli in the smear in this case reaches the norm of 95%.

Single squamous epithelial cells may be present, and the vaginal pH is acidic. Pathogenic microorganisms and leukocytes are absent.

Level 2 vaginal cleanliness

With the second degree of vaginal cleanliness, the smear reveals 80-95% lactobacilli and a small number of opportunistic microorganisms, as well as single epithelial cells (no more than 5) and leukocytes (no more than 10) and epithelial cells, the pH of the vagina is acidic.

The second degree is typical for most healthy women and, like the first, is considered the norm.
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3 degree of vaginal cleanliness

With the third degree of vaginal cleanliness, the smear contains more opportunistic microorganisms than lactobacilli, and this indicates the presence of an inflammatory process, the pH of the vagina is alkaline or neutral.

The smear reveals leukocytes (10 – 30) and epithelial cells. A woman may be bothered by pathological discharge, itching and burning in an intimate place.

4 degree of vaginal cleanliness

The fourth degree of vaginal purity - this means that the analysis revealed a lot of pathogenic bacterial flora, leukocytes (more than 50) and epithelial cells (more than 15 - 20) with a small number of Doderlein rods, the vaginal environment is strongly shifted to the alkaline side.

In some patients, lactobacilli are not detected at all. This condition indicates the development of bacterial vaginosis or another infectious and inflammatory disease.

The woman has clear symptoms of an infectious disease.
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With the third and fourth degree of vaginal cleanliness, drug treatment with broad-spectrum antibiotics is required. Antibacterial therapy is prescribed taking into account the sensitivity of pathogenic microorganisms.

Interpretation of smear results for flora in women

It's no secret that with the development of technology, medicine and the improvement in the quality of life, the number of various diseases not only does not decrease, but is constantly growing.

Today, every fifth person suffers from infectious diseases of the reproductive system, and often a person finds out about the disease too late. That is why doctors strongly recommend using contraceptives and regularly undergoing tests for hidden infections.

Smear for infections: purpose

A smear test for infections is important as it can reveal hidden diseases

Despite the fact that leukocytes in the body perform a protective function (their normal presence and activity determine the body’s ability to resist invading bacteria), the detection of a large number of them in a gynecological smear for flora may indicate the presence of problems. Each visit to a gynecologist in a antenatal clinic should involve the mandatory collection of material from the urogenital tract for analysis (smear for flora). A smear is taken from women during periodic examinations for prevention, during planning and during pregnancy, as well as after childbirth, to monitor the condition of the female body.
A gynecological flora smear is necessary to determine the number of leukocytes in the smear, as well as the presence of beneficial and pathogenic bacteria.

Elevated leukocytes in a smear for flora indicate the presence of an inflammatory or infectious process occurring in the body.

Preparing for a smear test

For maximum reliability of the results of a smear on the flora, a woman needs to prepare.

How to prepare for a flora smear:

• Avoid sexual intercourse for 2 days
• do not douche for 2 days
• 1 day before, eliminate the use of vaginal suppositories and creams, as well as taking pills
• 2 hours before the test, avoid urinating
• You can only wash yourself the night before the analysis, with warm water without soap.
• It is prohibited to take a smear test during menstruation

The day before the flora smear, spermicidal preparations and intimate hygiene products with antibacterial action should not be used.
Remember that violation of these rules can lead to false results of a smear on the flora, such as increased leukocytes when they are normal, as well as a normal number when there are a large number. This will complicate the diagnosis of inflammatory processes occurring in the body and can lead to incorrect diagnosis and incorrect treatment.

Collection of materials for flora smear

When taking material for flora analysis, a smear of the contents of the vagina, cervix and urethra is taken. The sampling itself is performed strictly with disposable sterile instruments:

Tools for taking a smear on the flora:

• from the urethra - cytobrush, Volkmann spoon or bacterial loop
• from the vagina - a sterile gauze swab
• from the cervix - Eyre spatula

During the collection of material for a smear, the woman is placed in a gynecological chair, and the collection of the material itself takes a couple of minutes and is usually painless.
The collected material is placed on glass slides, conventionally marked with the following symbols:
U – urethral smear, C – cervical smear, V – vaginal smear.
The slides are then sent to the laboratory, where they are stained and examined under a microscope. During the analysis, the number of leukocytes, opportunistic and pathogenic bacteria is calculated.

Deciphering a smear for flora

White blood cells in a smear in women are normally 15 units per field of view. However, to get a more detailed picture, the number of white blood cells is determined from samples taken from the vagina, urethra (urethra) and cervix.

The norm of leukocytes in the urethra (urethra) is up to 10 in the field of view, in the vagina up to 20 units, in the cervix up to 10 leukocytes.

Leukocytosis is a condition in which the white blood cells in the smear are elevated. It is usually divided into minor, moderate and pronounced.
Insignificant leukocytes in a smear is a definition of up to 20 leukocytes. In the absence of accompanying symptoms and indicators, this type of leukocytosis is not considered dangerous. By the way, a physiological increase in leukocytes occurs during pregnancy, during the body’s recovery after childbirth, and also immediately before the onset of menstruation.
With a more significant increase in leukocytes in the smear, as well as in the presence of such accompanying symptoms as inflammation of the genitourinary system, itching and burning, swelling of the genitals, painful and frequent urination, curdled, bloody, purulent discharge, unpleasant odor of discharge, menstrual irregularities, Painful sensations during sexual intercourse require a number of additional tests to prescribe adequate treatment.
Body temperature, lethargy and fatigue may also occur.

A smear on the flora shows:

• a small number of lactobacilli - dysbacteriosis (dysbiosis) of the vagina
• Candida fungi detected - candidiasis
• Trichomonas detected - trichomoniasis
• gonococci detected - gonorrhea

If an increased number of leukocytes is detected (the indicator in the smear is increased), the doctor prescribes additional tests of blood and vaginal and cervical secretions using PCR diagnostics and ELISA (enzyme-linked immunosorbent assay) to detect other sexually transmitted infections, as well as bacterial culture to determine the sensitivity of bacteria to types of antibiotics when they are detected. In addition, an ultrasound of the pelvic organs is prescribed. After receiving the results of all studies, treatment is prescribed.

Why are leukocytes in the smear elevated?

The main reason for detecting a large number of leukocytes in a smear is considered to be the presence of infections. Bad (pathogenic) bacteria can enter the female body through sexual intercourse, unprotected sexual intercourse, as well as through household contact with a carrier of infections (STIs - sexually transmitted infections).
Also, the cause of elevated white blood cells may be the presence of herpes viruses, papilloma, cytomegalovirus, HIV.
A large number of leukocytes in a smear does not always mean the presence of a sexually transmitted infection; this can be a consequence of trauma to the genital organs during sexual intercourse, after childbirth, in chronic and acute forms of kidney disease, in diabetes mellitus, as well as in tumors. In any case, if elevated leukocytes are detected in the smear, further examination by the attending physician is required.

Infections that cause an increase in white blood cells on a smear:

• Gonococci - lead to the disease gonorrhea
• Spirochete pallidum (syphilis)
• Klebsiella (granuloma inguinale)
• Chlamydia (chlamydia)
• Gardnerella (garderellosis or bacterial vaginosis)
• Koch bacillus (tuberculosis)
• Fungi Candida albicans (thrush or candidiasis)
• Protozoal infection (trichomoniasis)
• Mycoplasmas and ureaplasmas (mycoplasmosis and ureaplasmosis)

Reasons for increased leukocytes in a smear:

• Colpitis (inflammation in the vagina)
• Cervinitis (inflammation of the cervix)
• Endometritis (inflamed uterine mucosa)
• Urethritis (inflammation of the urethra)
• Cystitis (kidney disease)
• Andexitis (inflamed appendages)

We should also talk about such a concept as vaginal dysbiosis (gardnerellosis). Normally, in a woman’s vagina, 98% of all bacteria are beneficial lactobacilli. And only 5% are other microorganisms, which are called opportunistic. The immune system and beneficial bacteria control and inhibit the growth of opportunistic bacteria. However, against the background of ongoing diseases or inflammation, this ratio of beneficial and harmful bacteria is disrupted, the number of harmful bacteria increases and dysbiosis occurs.

Causes of vaginal dysbiosis:

• Hormonal disorders, hormone intake
• Taking antibiotics
• Kidney diseases
• Pregnancy and childbirth
• Decreased immunity
• Use of spermicidal drugs
• Taking cytostatics
• Poor intimate hygiene
• Allergic reactions to intimate hygiene products
• Stress
• Anal, oral and vaginal sex in one sexual act

When these causes are eliminated, vaginal dysbiosis goes away quite quickly, and the vaginal flora returns to normal.

Smear during pregnancy

During the normal course of pregnancy, to monitor the condition of the expectant mother’s body, a smear on the flora is taken at least 3 times:

Smear in pregnant women:

• when registering a pregnant woman
• at 30 weeks before going on maternity leave
• at 36 weeks

The norm of leukocytes in a smear during pregnancy increases to 20 units in the field of view.

This increase is associated with transformations in the female body.
It is important to remember that in no case should you ignore elevated white blood cells in a smear in a pregnant woman, as this can lead to complications during pregnancy, infection of the fetus and premature termination of pregnancy.

Pap smear after birth

When taking a smear for flora after childbirth, an increased level of leukocytes, up to 45 units, can also be detected. This is considered normal for this condition, since the body has suffered stress and tissue restoration is occurring. If there are no complaints, a smear on the flora after childbirth is prescribed approximately on the 40th day (before this date, the results may be unreliable). An exception to this rule is made if treatment for a sexually transmitted disease (STD) occurred during pregnancy.

Treatment

It is important to understand that when treating abnormal smear values, a targeted fight against the cause of elevated white blood cells is necessary, and not just with bringing their number to normal.

Candles

Candles (suppositories) are used in the treatment of disorders of the female genital organs.

Candles for the treatment of female diseases:

Group	Examples	Doses
Antifungal (against thrush)	Pimafucin	1 candle at night, 6‒10 days
	Livarol	1 candle at night, 6‒12 days
Anti-inflammatory	Revmoxicam	1 suppository 2 times a day, rectally, 5 days
	Dicloberl	1 suppository once a day, rectally, 5 days
Antibacterial	Hexicon	1-2 suppositories per day, 14 days
	Betadine	1 candle per day, 7 days
Healing	sea ​​buckthorn oil	1 candle per day, 7 days
	Vagical	1 suppository per day, 8 days
Complex	Terzhinan
	Polygynax	1 capsule intravaginally, 10 days
Antimicrobial	Flagyl	1 candle per day, 10 days
	Trichopolum	1 tablet per day, 10 days

Douching

To wash and cleanse the genital areas, douching with miramistin, chlorhexidine, ioddicerin and potassium permanganate solutions is prescribed. This procedure is intended to cleanse and disinfect the vaginal mucosa. Douching is performed 1-2 times a day for 7 days.
Douching is contraindicated for pregnant women.

Treatment of external genitalia

For pregnant women, it is allowed to treat the external genitalia with antiseptic agents (furacilin, citeal, chlorhexidine, betadine) after a shower.
In addition, there are creams applied externally (Macmiror, Kolpotrofin, Lomexin).

Antibiotics

Antibiotics are used to treat sexually transmitted infections.

Immunomodulators

To strengthen the body's immunity, immunomodulators are also prescribed.
Immunomodulators for gynecological diseases:

Folk remedies

Gynecological inflammations are also treated with folk remedies. Among them are the following: douching with solutions:

Douching with solutions:

• with sage herbs
• with iodine
• with salt and soda
• with garlic
• with whey

There are also tampons containing mixtures of aloe and honey. However, this type of medication must be used strictly on the recommendation of the attending physician in order to prevent complications.

If sexually transmitted infections are detected, treatment should be prescribed to both partners, otherwise re-infection is possible.

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