Analysis of smears from the urethra

With the initial examination of smear preparations from the urethra, the following practical conclusions can be drawn.

• Leukocytes predominate (neutrophils and lymphocytes) - acute urethritis or exacerbation of chronic urethritis; with a high content of eosinophils (more than 5-10%) - allergic urethritis.
• Epithelial cells predominate with a small number of leukocytes - chronic urethritis with metaplasia of the epithelium (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 mucosa, etc.
• Leukocytes are absent or only single in the field of view with a large increase in the microscope - prostatea (there are lipoid grains); spermatorrhea (many spermatozoa); urethrorrhoea (mucus predominates without uniform elements - the secret of urethral glands).
• With a small content of polynucleotide neutrophils, massive accumulations of small pleomorphic rods on the cells of the epithelium (key cells) are urethritis caused by Corynebacterium vaginale.
• There are key cells, a large number of different bacteria, polynucleated neutrophils are single, phagocytic reaction is absent - bacteriorea.

With a more detailed study of smears from the urethra, the criteria for the diagnosis of urethritis according to the European guidelines on urethritis (2001) are as follows.

• A Gram-smeared urethra smear containing at least 5 linearly neutrophilic neutrals in the field of view with a large magnification (× 1000) of the microscope (mean of 5 or more fields with the highest concentration of polynucleated neutrophils) and / or:
• detection of at least 10 polynucleated neutrophils in the field of view with a large magnification (× 1000) of the microscope (average of 5 or more fields with the highest concentration of polynucleated neutrophils) in the Gram stained specimen from the sample of the first portion of urine.

The sensitivity of the above tests depends on how long the patient did not urinate before taking the material for the study. Usually a 4 hour interval is recommended.

If an inflammatory process is detected in the urethra, it is necessary to establish its etiology. Urethritis can be either gonococcal (with Neisseria gonorrhoeae ), or non-gonococcal (gonococci do not reveal). A significant proportion of non-gonococcal urethritis is due to chlamydia. Cases in which it is not possible to detect either chlamydia or gonococci are referred to non-gonococcal non-chlamydial urethritis (nonspecific urethritis).

For examination, gonococci are simultaneously taken from the urethra, prostate gland, urine in men and separated from the vagina, cervix, para-urethral ducts, rinsing water of the rectum in women. For diagnosis, a bacterioscopic method is used (Gram staining), which in acute gonorrhea in men has a high sensitivity and specificity (95% and 98%, respectively). In chronic and treated cases of disease in men, a positive result is observed only in 8-20% of cases. In men, in acute cases, the urethra is affected, in the chronic - the prostate gland, seminal vesicles; women are primarily affected by bartholin glands, vagina and urethra, later - the mucous membrane of the cervix, fallopian tubes, rectum, girls - the vagina, urethra, rectum, eye conjunctiva. A single negative result is not conclusive, so repeated studies are needed.

In the study of smears in patients with gonorrhea, a bacterioscopic picture of three species is mainly observed:

• leukocytes cover the whole field of vision, gonococci are often located intracellularly, some of them are localized extracellularly; other microorganisms are absent;
• the cell picture is the same, but there are no gonococci and extraneous microflora (this pattern is characteristic of chronic gonorrhea);
• a small amount of degenerated leukocytes and abundant extraneous 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 found in men and extremely rarely in children. The causative agent of the disease is Trichomonas vaginalis. The disease in women is characterized by fluid, foamy or purulent discharge, irritation of the mucous membrane of the vagina. In most men, the disease runs unnoticed, in a number of cases, the so-called "morning discharge" (discharge from the urethra of a drop of pus) is noted, and only a small part of the infection takes an acute form with the phenomena of urethritis and prostatitis. In women Trichomonas are found mainly in the vulva and the vagina, less often in the urethra, the cervix of the uterus. In men, the urethra, prostate, seminal vesicles are affected.

Chlamydia. Bacteriologic methods of chlamydia infection are rarely diagnosed, mainly using serological methods or PCR.

Candidiasis. Candida is the most frequent pathogen of mycotic urethritis, sexually transmitted. Much less often, candidal urethritis develops as a consequence of dysbiosis after treatment with antibiotics. In smears from the urethra, a mycelium and spores are found, which confirms the diagnosis.

[1], [2], [3], [4], [5], [6], [7], [8], [9], [10]