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Pelvi-périnéologie

, Volume 3, Issue 1, pp 19–24 | Cite as

Les sécrétions vaginales

  • J. -M. Bohbot
Mise Au Point / Update
  • 58 Downloads

Résumé

Les leucorrhées sont un des motifs de consultation les plus fréquents en gynécologie. Les modifications des leucorrhées portent sur l’abondance mais aussi la couleur, la consistance et l’odeur. Des signes d’accompagnement comme le prurit, les brûlures locales ou l’existence de lésions permettent d’orienter le diagnostic. Il faut distinguer, d’une part, les leucorrhées physiologiques, dont les variations sont liées à des modifications hormonales ou à des conditions particulières comme la grossesse ou la ménopause, et les leucorrhées pathologiques d’autre part. Dans ce domaine, les infections sont de loin les plus fréquentes (vaginites candidosiques, bactériennes, vaginose bactérienne). Le diagnostic étiologique peut être évoqué sur certains critères cliniques, mais le recours aux examens biologiques est indispensable en cas de récidives. Un grand nombre d’infections génitales basses sont liées à un déséquilibre de la flore vaginale avec modifications quantitative ou qualitative de la flore lactobacillaire. C’est la raison pour laquelle, à côté des traitements anti-infectieux classiques, la thérapeutique actuelle accorde une place grandissante aux traitements de terrain, c’est-à-dire aux produits destinés à rééquilibrer l’écosystème vaginal comme les probiotiques. Des études supplémentaires sont nécessaires pour déterminer la composition idéale de ces probiotiques, leurs indications précises et leurs modalités d’utilisation.

Mots clés

Leucorrhées Vaginites Vaginose Probiotiques 

Vaginal discharge

Abstract

Vaginal discharge is one of the most common complaints in gynecology practice. Vaginal discharge changes involve abundance as well as colour, consistency or smell. Associated symptoms such as pruritus, localized burning or lesions can provide a diagnosis. Physiological vaginal discharge due to hormonal changes or specific conditions such as pregnancy or menopause must be distinguished from pathologic leucorrhea. In this context, most of them are due to infections (vaginal candidiasis, bacterial vaginitis, bacterial vaginosis). Clinical criteria can help with the diagnosis, but bacteriological examination of vaginal smears is necessary in the event of recurrence. Most of these infections are due to an imbalance of vaginal flora with quantitative or qualitative changes in lactobacilli. It is the reason why, aside from traditional anti-infective treatments, there is increasing interest in treatments, which could promote vaginal colonization of lactobacilli such as probiotics. Further studies are needed to define the ideal composition of probiotics and their exact indications and conditions for use.

Keywords

Vaginal discharge Vaginitis Bacterial vaginosis Probiotics 

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Références

  1. 1.
    Reid G (2002) Probiotics for urogenital health. Nutr Clin Care 5: 3–8 (Abstract)PubMedCrossRefGoogle Scholar
  2. 2.
    Devillard E, Burton JP, Hammond JA, et al. (2004) Novel insight into the vaginal microflora in postmenopausal women under hormone replacement therapy as analyzed by PCR-denaturing gradient gel electrophoresis. Eur J Obstet Gynecol Reprod Biol 10; 117(1): 76–81CrossRefGoogle Scholar
  3. 3.
    Eschenbach DA, Thwin SS, Patton DL, et al. (2000) Influence of the normal menstrual cycle on vaginal tissue, discharge, and microflora. Clin Infect Dis 30(6): 901–907PubMedCrossRefGoogle Scholar
  4. 4.
    Verhelst R, Verstraelen H, Claeys G, et al. (2005) Comparison between Gram stain and culture for the characterization of vaginal microflora: definition of a distinct grade that resembles grade I microflora and revised categorization of grade I microflora. BMC Microbiol 5: 61PubMedCrossRefGoogle Scholar
  5. 5.
    Vasquez A, Jakobsson T, Ahrne S, et al. (2002) Vaginal lactobacillus flora of healthy Swedish women. J Clin Microbiol 40(8): 2746–2749PubMedCrossRefGoogle Scholar
  6. 6.
    Lepargneur JP, Rousseau V (2002) Le rôle protecteur de la flore de Doderlein. J Gyn Obs Biol Reprod 31(5): 485–494Google Scholar
  7. 7.
    Al-Harti L, Roebuck KA, Olinger GG, et al. (1999) Bacterial vaginosis-associated microflora isolated from the female genital tract activates HIV-1 expression. JAIDS 21: 194–202Google Scholar
  8. 8.
    Velraeds M, Van der Mei HC, Reid G, et al. (1996) Inhibition of initial adhesion of uropathogenic enterococcus faecalis by biosurfactants from Lactobacillus isolates. Appl Env Microbiol 62: 1958–1963Google Scholar
  9. 9.
    Reid G (2001) Probiotic agents to protect the urogenital tract against infection. Am J Clin Nutr 73(suppl): 437–443Google Scholar
  10. 10.
    Gallay A (2007) L’épidémiologie des infections à gonocoques en France, 1996–2005 rapport INVSGoogle Scholar
  11. 11.
    Goulet V (2005) Les infections à Chlamydia trachomatis en France en 2003: données du réseau Rénachla. In: Surveillance nationale des maladies infectieuses, 2001–2003. Saint-Maurice: Institut de veille sanitaire, disponible sur http://www.invs.sante.fr/publications/2005/snmi/pdf/chlamydia_trachomatis.pdf Google Scholar
  12. 12.
    Warszawski J (2006) Dépistage systématique des infections à Chlamydia trachomatis: il est temps d’agir. BEH no 37-8Google Scholar
  13. 13.
    Sobel J (2006) Management of recurrent vulvovaginal candidiasis: unresolved issues. Curr Infect Dis Rep 8(6):481–486PubMedCrossRefGoogle Scholar
  14. 14.
    Schoeman J, Steyn PS, Odendaal HJ, et al. (2005) Bacterial vaginosis diagnosed at the first antenatal visit better predicts preterm labour than diagnosis later in pregnancy. J Obstet Gynaecol 25(8): 751–753PubMedCrossRefGoogle Scholar
  15. 15.
    Obel JD, Ferris D, Schwebke J, et al. (2006) Suppressive antibacterial therapy with 0.75 % metronidazole vaginal gel to prevent recurrent bacterial vaginosis. Am J Obstet Gynecol 194(5): 1283–1289CrossRefGoogle Scholar
  16. 16.
    Swidsinski A, Mendling W, Loening-Baucke V, et al. (2005) Adherent biofilms in bacterial vaginosis. Obstet Gynecol 106(5 Pt 1): 1013–1023PubMedGoogle Scholar
  17. 17.
    Saunders S, Bocking A, Challis J, et al. (2007) Effect of Lactobacillus challenge on Gardnerella vaginalis biofilms. Colloids Surf B Biointerfaces 55(2): 138–142 (Epub 2006 Dec 9)PubMedCrossRefGoogle Scholar
  18. 18.
    Falagas ME, Betsi GI, Athanasiou S, et al. (2007) Probiotics for the treatment of women with bacterial vaginosis. Clin Microbiol Infect 13(7): 657–64PubMedCrossRefGoogle Scholar
  19. 19.
    Orsen P, Vogel I, Olsen J, et al. (2006) Bacterial vaginosis in early pregnancy is associated with low birth weight and small for gestational age, but not with spontaneous preterm birth: a population-based study on Danish women. J Matern Fetal Neonatal Med 19(1): 1–7CrossRefGoogle Scholar

Copyright information

© Springer Paris 2008

Authors and Affiliations

  1. 1.Institut FournierParisFrance

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