All iLive content is medically reviewed or fact checked to ensure as much factual accuracy as possible.
We have strict sourcing guidelines and only link to reputable media sites, academic research institutions and, whenever possible, medically peer reviewed studies. Note that the numbers in parentheses ([1], [2], etc.) are clickable links to these studies.
If you feel that any of our content is inaccurate, out-of-date, or otherwise questionable, please select it and press Ctrl + Enter.
Why are white blood cells elevated in smears in women and men?
Medical expert of the article
Last reviewed: 05.07.2025
One of the standard procedures performed during a gynecological examination is taking a smear from the vagina. Analysis of its composition is quite informative. Although it cannot tell about all pathological processes, it allows you to suspect something is wrong when leukocytes in the smear are elevated, and determine the direction of further diagnostic measures.
In the contents of the vaginal smear, which is taken most often, leukocytes are almost always determined, in the field of vision of the laboratory technician their number should be about 10-15. This is the norm, small deviations are allowed depending on where the scraping was made (vagina - 0-15, urethra - 0-5, cervix - 0-30). It is also possible that the human factor, both the patient and the laboratory technician, may influence the results of the study.
What does "increased leukocytes in a smear" mean?
In most cases, such a conclusion indicates the presence of an inflammatory process. White blood cells or leukocytes are direct participants in the body's immune response. They recognize external and internal foreign substances, try to destroy them, and also store information about the invasion of pathogens. All types of white cells are able to move quickly, penetrate the vascular membrane into the intercellular space, accumulate and destroy foreign agents there.
During a massive invasion of pathogens, active phagocytosis occurs, leukocytes die, unable to cope with the digestion of enemies - purulent discharge appears (dead leukocytes - neutrophils). Symptoms of acute inflammation increase - swelling, redness, soreness, itching, and an influx of new leukocytes.
If a woman feels symptoms of trouble and goes to a gynecologist with certain complaints, then elevated leukocytes are unlikely to surprise her. And when such a conclusion falls "out of the blue" after a preventive examination, then women start leafing through medical reference books and turn to the Internet, asking the sacramental question: "What does "elevated leukocytes in a smear" mean?
Let's focus first on the human factor. Since we can't influence the lab technician, we'll outline the rules for taking a smear that must be followed to ensure the result is as informative as possible.
It is best to take a smear immediately after the end of menstruation. In addition, it is necessary to refrain from sexual intercourse, taking analgesics and barbiturates for at least two days before taking the test. If the patient takes immunosuppressants, cytostatics or hormones, it is necessary to inform the doctor about this. The day before visiting the gynecologist, reduce physical activity (especially on the abdominal muscles and buttocks), do not use any vaginal products, medicinal and for intimate hygiene, do not douche, just wash with warm clean water. You do not need to take the test within a decade from the end of antibiotic therapy or, at least, warn the doctor about this. It is undesirable to empty the bladder for two hours before visiting the gynecologist, since this can wash away diagnostically significant components from the vaginal mucosa.
Agree, we do not always follow these rules before visiting a gynecologist. And failure to follow them can lead to a distorted result.
Causes elevated white blood cells in the smear.
The most probable cause of an increase in the immune system cell count in a scraping is an inflammatory process localized in the urogenital tract: vaginal (colpitis or vaginitis), the mucous membrane of the cervical canal or the uterus itself (exo- and endocervicitis, endometritis), the urinary canal ( urethritis ); fallopian tubes and ovaries ( salpingo-oophoritis ). Sometimes the same smear also contains the culprits of the inflammation - gonococci, trichomonas, often their detection requires more modern and in-depth diagnostic methods that allow identifying chlamydia, ureaplasma, viruses and other infectious agents (PCR, ELISA, PIF diagnostics, sex hormone tests, cultural and cytological analysis of a smear, biopsy, ultrasound), as well as an examination of the general health of the patient (consultation of other specialists).
If the leukocytes in the smear are elevated due to cervical erosion, then the cause of this is not the defect in the structure of the mucous membrane itself, but the presence of an inflammatory process that apparently led to the appearance of erosion.
Depending on the type of infectious agent, inflammation of the genitourinary organs is divided into specific, most often caused by trichomonads, chlamydia, gonococci, mycoplasma and ureaplasma, tuberculosis bacilli, yeast fungi, viruses, and nonspecific, caused by various cocci, gardnerella, proteus, intestinal and pseudomonas aeruginosa. Opportunistic flora becomes the causative agent of the inflammatory process when favorable conditions for this are created in the body - decreased immunity. Nevertheless, the division of infections into those caused by absolutely and opportunistic pathogenic microorganisms is relative, since inflammations are mainly caused by associations of microbes.
Infectious agents (specific) are transmitted mainly during sexual contact, sometimes by contact-household means when using common hygiene items. The second way usually infects in childhood.
The cause of the inflammatory process may be a violation of the vaginal microflora. With a decrease in the concentration of lacto- and bifidobacteria, active development of opportunistic microorganisms begins, in particular, yeast fungi Candida or gram-variable flora. This is why increased leukocytes are found in a smear with thrush, which can be caused by both taking antibiotics and ureaplasmosis, mycoplasmosis, chlamydia. Therefore, additional diagnostics are required.
Inflammation of the external genitalia can be caused by an allergic reaction to medications and herbal preparations, intimate hygiene products, local contraceptives, and even a partner’s sperm.
Malignant neoplasms can cause a high concentration of leukocytes in a smear, since the destructive process is also accompanied by inflammation.
The level of leukocytes changes under the influence of sex hormones even during the menstrual cycle, as well as with fluctuations in hormonal levels during puberty and menopause, in pregnant women, immediately after an abortion and childbirth, in endocrinologist patients, with ovarian dysfunction. Therefore, do not panic if you notice increased leukocytes in a smear before menstruation. A few days before the expected menstruation, the number of white blood cells (without signs of destruction) in a scraping from the vaginal mucosa can be 35-40 units in the field of view. In the same way, slightly increased leukocytes in a smear during menopause, during pregnancy should not be frightening. However, high levels of immune system cells even during periods of hormonal fluctuations indicate the presence of an inflammatory process, especially if leukocytes have morphological transformations associated with their protective activity.
Risk factors
Risk factors for leukocytosis in the contents of scrapings from the urogenital tract mucosa may be associated with:
- with decreased immunity due to stress, fatigue, hypothermia, taking antibiotics, chemotherapeutic and other drugs;
- with mechanical irritation as a result of intense sex, uncomfortable synthetic underwear or trousers;
- with frequent changes of sexual partners, unhealthy lifestyle;
- with spermicidal contraception;
- with the installation of an IUD within the next ten days;
- with insufficient or, conversely, too conscientious performance of hygiene procedures (for example, a passion for douching with the use of medications);
- with frequent use of hygienic vaginal tampons;
- with intestinal dysbacteriosis;
- with systemic diseases;
- with recent (within 24 hours) sex before taking the smear;
- with another deviation from the rules for submitting the test.
Symptoms elevated white blood cells in the smear.
A smear for vaginal microbiocenosis is taken from the patient during a visit to the gynecological office each time, both in the presence of complaints and during a preventive examination.
The first signs of trouble that should prompt a woman to come to the doctor for an examination are a change in the appearance of vaginal discharge, discomfort during emptying the bladder, itching and burning in the area of the external and internal genitalia, pain in the lower abdomen, discomfort during coitus.
Strongly increased leukocytes in the smear and discharge make one think about an inflammatory process. Inflammation reveals a sufficient number of neutrophils that have died in the fight against foreign substances of leukocytes, and a considerable amount of mucus. In addition, bacteria (rods and cocci), fungi are sown in the smear, and lacto- and bifidobacteria are usually insufficient.
Vaginal discharge that causes discomfort in the form of severe itching and has an unpleasant odor may indicate vulvovaginitis, colpitis, cervicitis, or endometritis.
Discharge: purulent, foamy, gray-green, whitish, curdy, are a sign of specific inflammation.
Pain during sexual intercourse usually accompanies inflammatory diseases of the uterus, its cervix, fallopian tubes or ovaries.
Increased leukocytes in a smear in women who have noticed an unstable menstrual cycle may indicate inflammation of the ovaries or another pathology.
Leukocytosis in combination with frequent and painful emptying of the bladder indicates the presence of urethritis or cystitis, and with false and frequent urges to empty the bowels - about its possible dysbacteriosis.
An unconditional inflammatory process corresponds to the following entry: leukocytes in a smear 50 or more. Sometimes their number cannot be counted, and then the laboratory technician's conclusion may look like "leukocytes all over the field of vision." Such a formulation indicates acute inflammation and the need for immediate treatment. Such a smear usually contains not only leukocytes, but a lot of mucus and other pathogenic and opportunistic microorganisms, for example, epithelial cells seeded with gardnerella, the so-called key cells. This is a symptom of bacterial vaginosis.
Women often search the Internet for answers after receiving the test results and apparently not being satisfied with the doctor's explanations. But it is impossible to make a diagnosis based on just one indicator of leukocytes in the field of view; other indicators must also be analyzed. Even if only leukocytes are elevated, this does not exclude the presence of, for example, chlamydia, which is diagnosed by other methods.
If the leukocytes in the smear are elevated 40-50 and there are other symptoms (discharge, discomfort, etc.), then the presence of trouble is certain. In the absence of other symptoms, you can retake the smear, observing all the rules for taking the test, their violation can provoke a false result and a more impressive one.
Leukocytes in a smear of 35-40 may be a sign of both a chronic sluggish inflammatory process and an inappropriate time for taking the test (for example, a routine preventive examination by a gynecologist organized at work).
The same can be said about the indicator "leukocytes in a smear 20-25", which differs even less from the norm. Even if nothing bothers you, and you are confident in your health, it is still worth playing it safe and re-taking the smear, while observing all the rules. The human factor also cannot be ignored, but it is unlikely that the lab technician will make a mistake twice.
When cocci and increased leukocytes are detected in the smear, then at least bacterial vaginitis is present - the development of pathogenic flora due to a violation of the vaginal microbiocenosis. This condition can be caused by various reasons, from self-infection due to improper washing to hormonal, anatomical and immune disorders. In addition, the presence of cocci does not exclude the possibility of detecting other inflammation provocateurs, and therefore additional diagnostics - PCR, ELISA and others.
If leukocytes are persistently elevated and nothing is found, do not hide your head in the sand, but get checked for oncopathology. A timely diagnosis will save your life, because the reproductive organs are not considered vital.
Leukocytes in a smear during pregnancy are often elevated, especially in the second half. In the first half, with a physiological decrease in immunity, inflammatory processes in the genitourinary organs are possible. A slight increase in leukocytes in the absence of other symptoms should not cause concern, and the inflammatory process must be eliminated.
When leukocytes are elevated in a smear after childbirth, this is most likely a symptom of an inflammatory process associated with a violation of the vaginal microflora, with a dormant infection or a new infection. The same applies to abortion. The recommendations in this case are the same for everyone. In the absence of other symptoms, you can retake the test and undergo a more thorough examination. It is not the elevated leukocytes that are treated, but the cause that caused their increase, which must be established.
Elevated leukocytes in a smear in a child are usually detected when the child is bothered by other symptoms, because a smear is usually not taken from children for preventive purposes. A child can become infected with any infection by contact and household means from parents, therefore, he must be carefully examined and treated by a competent specialist.
Complications and consequences
Test results showing abnormalities in the quantitative indicators of immune cell content should at least be rechecked.
What is the danger of increased leukocytes in a smear? The possibility of an inflammatory process, ignoring which can lead to reproductive dysfunction, ectopic pregnancy, proliferation of connective tissue strands in the small pelvis, uterine pathologies and advanced oncological processes.
An elevated level of leukocytes in the expectant mother is dangerous due to spontaneous abortion, infection of the child in utero or during childbirth, premature or complicated childbirth, and complications in the postpartum period.
Treatment elevated white blood cells in the smear.
The Internet is full of questions: What to do if leukocytes in a smear are elevated? How to get rid of leukocytes in a smear?
It seems that trust in doctors is minimal, because no adequate doctor will treat elevated leukocytes and explain to the patient that this is just a laboratory indicator, a symptom, and it is necessary to find out the reason for such an increase.
However, we strongly advise you not to self-medicate, but to find a trustworthy doctor who will help you get rid of leukocytes in the smear.
Prevention
An increase in the level of leukocytes in a smear can be prevented, first of all, by avoiding infection of the urogenital tract, that is, promiscuous sexual relations, neglect of sanitary and hygienic standards.
Secondly, you need to take care of your immunity, hormonal background and general health by eating well and varied, getting enough rest and leading an active lifestyle.
If deviations in the smear composition indicators appear, it is necessary to find out the cause and eliminate it in a timely manner.
Forecast
Inflammatory diseases of the urogenital tract, which are mainly the cause of an increase in the number of leukocytes in a smear, are successfully treated. Modern medicine has a large arsenal of means for this.
Other causes are also treatable and are not life-threatening diseases, especially if you seek medical help in time.
The prognosis for resolving a situation where leukocytes in a smear are elevated depends entirely on the cause of the increase and the woman’s responsible attitude to her health.
[ 25 ], [ 26 ], [ 27 ], [ 28 ], [ 29 ], [ 30 ], [ 31 ], [ 32 ], [ 33 ]