Urethral swabs

During the initial examination of urethral smear preparations, the following practical conclusions can be made.

• Leukocytes (neutrophils and lymphocytes) predominate - acute urethritis or exacerbation of chronic urethritis; with a high content of eosinophils (over 5-10%) - allergic urethritis.
• Epithelial cells predominate with a small number of leukocytes - chronic urethritis with epithelial metaplasia (desquamative urethritis) or leukoplakia of the urethra.
• A significant number of erythrocytes along with leukocytes and epithelial cells - traumatic urethritis, urethral tumor, crystalluria, ulceration of the mucous membrane, etc.
• Leukocytes are absent or only single in the field of view at high magnification of the microscope - prostatorrhea (lipoid grains are present); spermatorrhea (many spermatozoa); urethrorhea (predominant mucus without formed elements - secretion of the urethral glands).
• With a low content of polynuclear neutrophils, massive accumulations of small pleomorphic rods on epithelial cells (clue cells) - urethritis caused by Corynebacterium vaginale.
• Key cells are present, a large number of various bacteria, single polynuclear neutrophils, phagocytic reaction is absent - bacteriorrhea.

On closer examination of smears from the urethra, the criteria for diagnosing urethritis according to the European Guidelines for Urethritis (2001) are as follows.

• A Gram-stained urethral smear containing at least 5 polynuclear neutrophils per high-power field (×1000) of the microscope (the average of 5 or more fields with the highest concentration of polynuclear neutrophils), and/or:
• detection of at least 10 polynuclear neutrophils per high-power (×1000) field of view (the average of 5 or more fields with the highest concentration of polynuclear neutrophils) in a Gram-stained preparation from a first-portion urine sample.

The sensitivity of the above tests depends on how long the patient has not urinated before the sample is taken. A 4 hour interval is usually recommended.

When an inflammatory process in the urethra is detected, its etiology must be established. Urethritis can be either gonococcal (when Neisseria gonorrhoeae is detected) or non-gonococcal (gonococci are not detected). A significant portion of non-gonococcal urethritis is caused by chlamydia. Cases in which neither chlamydia nor gonococci can be detected are referred to as non-gonococcal non-chlamydial urethritis (non-specific urethritis).

To test for gonococci, a discharge from the urethra, prostate gland, urine in men and a discharge from the vagina, cervix, paraurethral ducts, and rectal lavage in women are taken simultaneously. For diagnosis, a bacterioscopic method is used (Gram staining of a smear), which has a high sensitivity and specificity (95 and 98%, respectively) for acute gonorrhea in men. In chronic and treated cases of the disease in men, a positive result is observed only in 8-20% of cases. In men, the urethra is affected in acute cases, and the prostate gland and seminal vesicles are affected in chronic cases; in women, the Bartholin glands, vagina and urethra are primarily affected, later the mucous membrane of the cervix, fallopian tubes, rectum, and in girls the vagina, urethra, rectum, and conjunctiva of the eyes. A single negative result is not conclusive, so repeated tests are necessary.

When examining smears from patients with gonorrhea, three types of bacterioscopic picture are mainly observed:

• leukocytes cover the entire field of vision, gonococci are often located intracellularly, some of them are localized extracellularly; other microorganisms are absent;
• the cellular picture is the same, but there are no gonococci or foreign microflora (this picture is typical for chronic gonorrhea);
• a small number of degenerated leukocytes and abundant foreign microflora, the appearance of which indicates an improvement in the course of the process (during treatment).

Trichomoniasis is widespread among women aged 2-40 years, less often it is detected in men and extremely rarely - in children. The causative agent of the disease is Trichomonas vaginalis. The disease in women is characterized by liquid, foamy or purulent discharge, irritation of the vaginal mucosa. In most men, the disease proceeds unnoticed, in some cases the so-called "morning discharge" is noted (discharge of a drop of pus from the urethra) and only in a small number of cases the infection takes an acute form with phenomena of urethritis and prostatitis. In women, trichomonads are found mainly in the vulva and vagina, less often in the urethra, cervix. In men, the urethra, prostate, seminal vesicles are affected.

Chlamydia. Chlamydia is rarely diagnosed by bacterioscopic methods; serological methods or PCR are mainly used.

Candidiasis. Candida is the most common pathogen of mycotic urethritis, transmitted sexually. Much less often, candidal urethritis develops as a consequence of dysbacteriosis after antibiotic treatment. Mycelium and spores are found in smears from the urethra, which confirms the diagnosis.

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