Results of smear on flora: leukocytes, erythrocytes, epithelium, mucus

A gynecological or urological smear is a study of not only the microflora that lives inside our body, but also other components of the internal environment, which can also carry important information for diagnosis. Before dealing with a specific composition of flora in a smear, doctors (technicians) assess the presence and number of epithelium cells, blood and the immune system, as well as the quality and effectiveness of the processes occurring inside the body.

But we will understand in order that the various records and marks in the forms of smear analysis on the microflora denote. And start with leukocytes. As we know from the school course of biology, white blood cells are called leukocytes, whose main activity is the protection of the organism. Penetrating through the wall of blood vessels, they infiltrate infected tissue and begin to fight infection.

Leukocytes in a smear on flora

There are almost always present, which ensures the health of its microflora. But in the absence of active reproduction of conditionally pathogenic microorganisms and the introduction of pathogenic microbes, the number of leukocytes is limited. Thus, in a normal smear, up to 5 leukocyte units in the field of view are found in men. In females, the number of leukocytes may vary depending on the area in which the smear is taken. The rate of leukocytes in a smear for flora taken from the urethra and vagina ranges from 0 to 10 in sight. Analysis of the uterus secreted from the cervical canal should show no more than 30 white blood cells per field of view.

The above white blood cell count is not evidence of inflammation. These are normal indicators that are available in healthy men and women. About the inflammatory process they say, if the number of leukocytes is increased (leukocytosis). But it is important to understand that the number of leukocytes in the blood is not constant, it increases after a meal, mental or physical overstrain, and just in the evening, it is not surprising that giving blood for analysis provides for the elimination of the above factors.

True, considering the issue of smear analysis, we are not talking about the total number of leukocytes in the blood, but only about those white bodies that go into the tissues for pest control. All leukocytes are able to fight infection, but among them there is a group of cells that reduces the number of bacteria by their absorption and digestion. Such cells are called phagocytes, and the process of such a fight against pathogens is called phagocytosis.

Thus, phagocytosis in a smear on the flora can be viewed as a positive process for the natural fight against infection, which is regulated by the immune system. That is, if local immunity cannot prevent the development of an infection (for example, if the tissue of the skin or mucous membrane is damaged), phagocytes are involved. By absorbing bacterial cells, phagocytes increase in size and, eventually, are destroyed with the release of substances that provoke a local inflammatory reaction. That is, inflammation is provoked not only by the waste products of bacteria, but also by the dying defense cells.

Inflammation is accompanied by hyperemia, edema, temperature increase in the inflammatory focus, which is also carried out with the aim of destroying germs and attracting other leukocytes to the focus. The pus secreted in the foci of inflammation contains the “bodies” of the dead during the performance of their responsible function of leukocytes.

During phagocytosis, a smear analysis will show a large number of both active and dead leukocytes, which indicates an intensive fight of the body against infection, but at the same time confirms the fact of the presence of an active infection. And, despite all the positive aspects of this process, there are situations when phagocytosis remains incomplete, i.e. Not all bacteria or viruses are destroyed. Some remain undigested inside phagocytes due to the weakness of these cells, while others, equipped with special protection against recognition, penetrate into the cell and lead a hidden lifestyle. At the same time, the inflammatory process becomes chronic or sluggish, gradually weakening the body and creating optimal conditions for the reproduction of other pathogens.

If phagocytosis is found in a smear, physicians must determine its cause and, if necessary, provide medicinal assistance to the immune system so that the phagocytosis process is completed.

[1], [2], [3], [4], [5]

Erythrocytes in a smear on flora

In addition to leukocytes, our blood also contains red blood cells, the number of which is much more than white. These cells are not able to penetrate through the walls of blood vessels, therefore, normally the internal environment of the vagina or urethra should not contain red blood cells. Red blood cells in a smear on the flora indicate damage to the walls of the organs and their capillaries.

Separate erythrocytes (1-3 cells) can be found in a smear of a woman taken on the eve of menstruation or a short time after their completion, when the vagina has not yet had time to completely clear. If a smear is taken immediately after the end of menstruation, the number of red blood cells may be 25-30 units or more, which makes it difficult to recreate the true picture of the internal environment.

The number of red blood cells in a mid-cycle smear can vary for several reasons:

• injury to the mucous during the pelvic examination,
• recent injuries during hygiene procedures or sexual intercourse (why it is recommended to refrain from vaginal sex before taking a smear),
• injuries after the introduction of foreign bodies into the vagina, for example, the installation of the intrauterine device, unconventional ways to achieve sexual satisfaction, surgical interventions,
• hormonal disorders, accompanied by daubs or release of fresh blood,
• erosion on the walls of internal genital organs (for example, on the cervix),
• tumor diseases
• active inflammatory process in which microdamages are always detected in the edematous tissues.

Erythrocytes in a urethral smear can also be detected during urinary and renal stone disease, when microdamages of the organs' walls are triggered by solid crystals of urinary sediment, as well as during tumor processes.

In men, a small number of red blood cells in the urological smear may be associated with injury to the urethra during the taking of biomaterial. But we can not exclude inflammatory diseases caused by trauma, infection penetration, allergic reaction, as well as tumor processes. In these cases, a noticeable increase in the level of white blood cells is striking.

As you can see, there are many reasons for the appearance of blood in the smear and the task of the doctor is to determine the one that caused the increase in red blood cells in the smear. The appearance of erythrocytes in significant quantities indicates hemorrhage of varying intensity. If we are talking about an infection, the red blood cells will not be so much as with injuries, but the level of white blood cells released to combat pathogens will be significantly increased. That is, the crucial role in the diagnosis is not played by the number of red blood cells, but by the ratio in the biomaterial of the white and red blood cells.

Epithelium in the smear for flora 

It is also not a pathology, but an indicator of the state of the vagina, which is regularly cleaned naturally. Flat epithelium is called the surface layer of cells in the vagina or uterus. Its cells are renewed every 5-7 days, while old, dead cells are peeled off and excreted in the composition of normal secretions in women (3-15 cells). So, the definition of single particles of the epithelium in a smear indicates the good health of the female reproductive system. In this case, doctors take into account the fact that in different phases of the menstrual cycle, the number of flat cells will be different.

As we can see, the requirements for the preparation and analysis time are not just a whim of doctors, but conditions that determine the value of the analysis, the truth of its results.

But back to situations where the squamous epithelium in the smear is more or less than the norm. In women of reproductive age, squamous epithelium is always present in the smear, and if it is not detected, we are talking about hormonal disorders, when metabolic processes in the epithelium occur irregularly and are not accompanied by the separation of outdated, cornified particles. In this case, there is a thinning or vice versa thickening (colpohyperplasia) of the mucous membrane, which happens when there is a deficiency of the female hormone estrogen.

If the analysis of flora in a smear  shows the deviation of the number of squamous epithelium in the direction of its increase, it usually speaks of the pathologies of the inflammatory plan and their consequences. The fact is that during the inflammatory process metabolic processes in the tissues change. Under the influence of infection and its metabolic products, many superficial mucosal cells die and peel off from the surface, so they are easily removed during the smear. And the inflammation of the vagina (vaginitis) is in the overwhelming majority of cases associated with infection, so doctors primarily imply an infectious process, especially if there is also an increase in the number of white blood cells. If at the same time in a smear identify the key cells we are talking about infectious vaginitis caused by gardnerella.

Another reason for the enhanced separation of epithelial cells is considered to be a disease such as leukoplakia, characterized by the appearance on the mucosa of individual corneous foci. Leukoplakia is considered to be a precancerous condition; therefore, in no case should the disease be ignored.

The true causes of the development of this severe disease are unknown to doctors; however, there are a number of factors that contribute to the development of mucosal pathology: traumatic injuries, chronic inflammatory processes, vaginal cell atrophy, hormonal abnormalities, vitamin A deficiency, heredity, etc.

In men, squamous epithelium should be detected in quantities not exceeding 10 cells in the field of view, otherwise it again concerns an inflammatory disease of the urethra (its nature is judged by the number of leukocytes) or leukoplakia.

In the vagina there is only a flat epithelium, but the appearance of a large number of cylindrical epithelium in a smear on the flora indicates deeper problems. The fact is that this type of epithelium, which borders on flat, is in the cervical canal of the uterus.

It is clear that the uterus of a woman, like her vagina, is regularly cleaned and renewed in a natural way, therefore the cylindrical epithelium is part of the normal discharge from women. But normally we are talking about the same 3-15 cells. If there are fewer, you can suspect a hormonal failure or abnormal changes, for example, ectopia (or erosion - replacement of the flat epithelium with a cylindrical, which is easily injured by the acidic environment of the vagina) or cervical dysplasia (change in the structure of the epithelium and the appearance of atypical cells in it), which belong to precancerous conditions.

But an increase in the smear of cylindrical cells most likely indicates inflammation in the uterus and cervical canal (less often in the vagina or urethra), but can also be evidence of uterine oncology, therefore additional studies are required, in particular, biopsy and histological examination of the biopsy. Other causes of a shift in the level of cylindrical cells in a smear can be: a sharp increase in the production of estrogen, which is accompanied by the development of endometriosis, damage to the cervix during surgery.

During menopause, a similar situation is observed with benign mastopathy, which once again confirms the regulation of the mammary glands and reproductive organs by the same hormones.

[6], [7], [8], [9], [10], [11], [12], [13]

Mucus in a smear on flora 

It is a normal component of vaginal discharge in women of reproductive age. Up to 12-14 years it is not produced, and after the onset of menopause, its amount significantly decreases. The mucus is secreted in the cervical canal and performs a protective function, helping to cleanse the uterus and vagina, protecting them from infection and moisturizing the mucous membrane.

Normally, mucus in women and girls who have reached puberty is no more than 4 ml per day. It has a viscous texture, translucent with a whitish tinge, odorless. But depending on the physiological state of the woman, the amount of mucus may vary. Most of it is in the first half of the menstrual cycle (especially during ovulation), and the minimum is recorded before menstruation, which should also be taken into account when deciphering smear results.

Normally, mucus is detected by analyzing the secreted vagina and cervix of the uterus, which is defined as a moderate amount. If it is found in smears from the urethra, then in insignificant quantities, but ideally it should not be there.

The mucus in the female reproductive system has a viscous consistency, so in a smear on the flora, or rather, its decoding, you can see the point “strands of mucus”. You should not be afraid of this expression, because the presence of mucus is not indicative, but its amount, which can also vary even in a healthy woman.

A large amount of secreted mucus most often speaks of vaginal dysbacteriosis and the inflammatory process in the reproductive system. Urethral mucus is evidence of inflammation in the urinary system, which is possible in both men and women.

Deciphering smear analysis for flora may contain other items that many women do not understand. For example, fibrin in a smear for flora is an insoluble protein that is usually found in the focus of inflammation. But to judge whether inflammation or not, you need only in conjunction with the study of the number and behavior of leukocytes. If single leukocytes are detected, the detection of fibrin is not associated with inflammation, but with features of smear. In this case, the woman has nothing to worry about.

Detritus in a smear on flora is a substrate consisting of exfoliated mucous membrane cells and dead bacteria. If we take into account that cell renewal occurs regularly, and that the composition of normal microflora contains various bacteria, both beneficial and conditionally pathogenic, the presence of detritus in the secreted vagina is quite understandable. Another thing is its amount, which can vary in different pathologies.

The microflora of the vagina is famous for the variety of life forms inhabiting it, and therefore the study of detritus gives doctors information about the flora contained in the smear, and hence in the woman's vagina. The volume of detritus is a more or less constant value, therefore its increase can be viewed as a deviation in the health of the fair sex. Most often we are talking about inflammation of the vagina (vaginitis), but infectious inflammatory processes of other localization should not be ruled out: urethritis (inflammation of the urethra), cervicitis (inflammation in the cervix of the cervix of the cervix) and endometritis (with localization of inflammation in the organ cavity), adnexitis (inflammation of the appendages). If the level of leukocytes is not elevated or increased slightly, perhaps the reason lies in vaginal dysbiosis.

But the expression "cytolysis in a smear for flora" denotes an imbalance of lactobacilli and always denotes pathology. As we know, lactobacilli are the bulk of bacteria in the normal microflora of the female vagina. It is about 95-98% of the total number of bacteria.

Most often, smears of lactobacilli can be found in smears, but sometimes they start to behave inadequately, actively multiply and the balance of microflora shifts towards increasing lactobacilli. It would seem that there is terrible, because thanks to these beneficial bacteria, the optimal acidity of the vagina is maintained, which prevents the pathogens from penetrating there to reproduce.

But after all, optimal acidity is one that does not destroy the body’s own cells. But with an increase in the number of lactobacilli, the production of lactic acid increases, which has an irritating effect on the delicate vaginal mucosa, which is accompanied by itching and burning. The irritation and destruction of the vaginal machine is called cytolysis, and the pathology is called cytolytic vaginosis.

Often this disease is combined with candida vagina, because the violation of microflora is always accompanied by a struggle for the territory of various microorganisms, and in this regard, the advantage remains for fungi that get along well with lactobacilli.

The causes of cytolysis are still a mystery for scientists, although it was possible to trace the relationship between the increase in the number of lactobacilli and the high level of glycogen in the second (lutein) phase of the menstrual cycle. This is because glycogen is a nutrient medium for lactobacilli, ensuring their activity and reproduction.

As you can see, even an experienced doctor is not so easy to interpret the results of urogenital smear. A variety of  flora in a smear  and its relationship with various processes occurring in the body, provide only basic information, which by analysis and comparison with the patient's medical history, complaints of well-being, the results of instrumental studies turns into a diagnosis.

For a layman, even with a medical education, it is very difficult to judge possible smears in the body or their absence by deciphering a smear. And what can we say about people far from medicine. Strange words and designations can be frightening, increasing the level of stress, which negatively affects the state of immunity. Experiencing about the result of the analysis, trying to find non-existent diseases in ourselves and without going to a doctor, we only prepare the ground for possible health problems, because weakened immunity can no longer withstand infections. In such conditions, it is possible that a reanalysis will indeed indicate pathology.

On the other hand, timely access to a doctor and the detection of pathology at an early stage allows you to restore health more quickly and with fewer losses. And if the result of the analysis is normal, then save your nerves (and with them the immunity), which will be a good prevention of infectious diseases.

[14], [15], [16], [17]