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<table border="1" cellpadding="5"><caption>Tableau 1 - Leucorrh&eacute;es</caption><tbody><tr><th colspan="2">Leucorrh&eacute;es physiologiques</th></tr><tr><td colspan="2"><ul><li data-w-id="995f8c47-2faa-ccf5-0e7f-be61d7fe7537" data-wf-id="[&quot;995f8c47-2faa-ccf5-0e7f-be61d7fe7537&quot;]" data-automation-id="dyn-item-diagnostics-input">Laiteuses ou translucides, peu abondantes, augmentant en p&eacute;riode pr&eacute;menstruelle,</li><li data-w-id="5e54d327-0b41-b666-419e-bcad6e2854b4" data-wf-id="[&quot;5e54d327-0b41-b666-419e-bcad6e2854b4&quot;]" data-automation-id="dyn-item-diagnostics-input">Inodores, non irritantes,</li><li data-w-id="f017be03-afb6-4731-cf92-070752c591c5" data-wf-id="[&quot;f017be03-afb6-4731-cf92-070752c591c5&quot;]" data-automation-id="dyn-item-diagnostics-input">Ne contiennent pas de polynucl&eacute;aire,</li><li data-w-id="c2980f4d-e5a1-8d1c-5a7e-fb4ed0e6191b" data-wf-id="[&quot;c2980f4d-e5a1-8d1c-5a7e-fb4ed0e6191b&quot;]" data-automation-id="dyn-item-diagnostics-input">Flore dominante = bacille de D&ouml;derlein.</li></ul></td></tr><tr><th colspan="2">Leucorrh&eacute;es pathologiques</th></tr><tr><td style="background-color: #bef2d3; text-align: center;" colspan="2"><strong>Diagnostic</strong></td></tr><tr><td style="text-align: center;"><strong>Clinique</strong></td><td><p>Signes &eacute;vocateurs d'une infection g&eacute;nitale :</p><ul><li data-w-id="a6cac40d-6336-44b2-5cb8-9fbee741b2c7" data-wf-id="[&quot;a6cac40d-6336-44b2-5cb8-9fbee741b2c7&quot;]" data-automation-id="dyn-item-diagnostics-input">Leucorrh&eacute;es malodorantes,</li><li data-w-id="88b0edd3-50d6-9cd1-834c-ea3909f128be" data-wf-id="[&quot;88b0edd3-50d6-9cd1-834c-ea3909f128be&quot;]" data-automation-id="dyn-item-diagnostics-input">Prurit ou br&ucirc;lures,</li><li data-w-id="c92c5a05-eec3-d1e0-fac2-4b69c272ed1f" data-wf-id="[&quot;c92c5a05-eec3-d1e0-fac2-4b69c272ed1f&quot;]" data-automation-id="dyn-item-diagnostics-input">M&eacute;trorragies, douleurs pelviennes ou signes g&eacute;n&eacute;raux associ&eacute;es (orientent vers une cervicite ou une infection g&eacute;nitale haute),</li><li data-w-id="0704fd2d-e4ef-9c0b-2b47-4ac572db9677" data-wf-id="[&quot;0704fd2d-e4ef-9c0b-2b47-4ac572db9677&quot;]" data-automation-id="dyn-item-diagnostics-input">Signes fonctionnels urinaires associ&eacute;s,</li><li data-w-id="b7a114ad-9316-6770-8ba1-6057686baa35" data-wf-id="[&quot;b7a114ad-9316-6770-8ba1-6057686baa35&quot;]" data-automation-id="dyn-item-diagnostics-input">Inflammation vulvaire, v&eacute;sicules, ulc&eacute;rations.</li></ul></td></tr><tr><td style="text-align: center;"><strong>Paraclinique</strong><br /><strong> (hors infection g&eacute;nitale haute)</strong></td><td><p>Pr&eacute;l&egrave;vement vaginal (<a href="https://www.ordotype.fr/ordonnances-types/prelevements-microbiologiques-leucorrhees" target="_blank" rel="noopener">ordonnance</a>) :</p><ul><li data-w-id="1234bc9b-cf6f-122d-bd3f-89adf389b540" data-wf-id="[&quot;1234bc9b-cf6f-122d-bd3f-89adf389b540&quot;]" data-automation-id="dyn-item-diagnostics-input">Examen direct &agrave; l'&eacute;tat frais,</li><li data-w-id="8c904b5b-19da-f993-64cc-38634d747dfe" data-wf-id="[&quot;8c904b5b-19da-f993-64cc-38634d747dfe&quot;]" data-automation-id="dyn-item-diagnostics-input">Analyse mycologique,</li><li data-w-id="62d71766-0721-9d0d-9ccb-bd65bf3d497a" data-wf-id="[&quot;62d71766-0721-9d0d-9ccb-bd65bf3d497a&quot;]" data-automation-id="dyn-item-diagnostics-input">Analyse bact&eacute;riologique,</li><li data-w-id="265bc0fd-d721-79a3-0cae-19cf07bd7d20" data-wf-id="[&quot;265bc0fd-d721-79a3-0cae-19cf07bd7d20&quot;]" data-automation-id="dyn-item-diagnostics-input">PCR Chlamydiae, gonocoque, mycoplasmes.</li></ul></td></tr><tr><td style="background-color: #def3e5; text-align: center;" colspan="2"><strong>Principales &eacute;tiologies</strong></td></tr><tr><td style="text-align: center;"><p data-w-id="4b6ddf45-4b67-5a9a-3f87-44ab1bee556e" data-wf-id="[&quot;4b6ddf45-4b67-5a9a-3f87-44ab1bee556e&quot;]" data-automation-id="dyn-item-diagnostics-input"><strong>Trichomonas</strong></p></td><td><ul><li data-w-id="016c4151-8b53-d2c1-1d7b-d12261ef896c" data-wf-id="[&quot;016c4151-8b53-d2c1-1d7b-d12261ef896c&quot;]" data-automation-id="dyn-item-diagnostics-input">Leucorrh&eacute;es verd&acirc;tres et naus&eacute;abondes,</li><li data-w-id="b8dfce5d-4f91-4330-434f-448ef0c930d9" data-wf-id="[&quot;b8dfce5d-4f91-4330-434f-448ef0c930d9&quot;]" data-automation-id="dyn-item-diagnostics-input">Traitement par m&eacute;tronidazole (<a href="https://www.ordotype.fr/ordonnances-types/traitement-vaginose-bacterienne" target="_blank" rel="noopener">ordonnance</a>),</li><li data-w-id="76be031d-1d0e-8b3a-cd7a-f32413a48bc8" data-wf-id="[&quot;76be031d-1d0e-8b3a-cd7a-f32413a48bc8&quot;]" data-automation-id="dyn-item-diagnostics-input">Traiter les partenaires sexuels,</li><li data-w-id="89bf73bd-31c4-5e8f-c3b1-1150e17cf508" data-wf-id="[&quot;89bf73bd-31c4-5e8f-c3b1-1150e17cf508&quot;]" data-automation-id="dyn-item-diagnostics-input">Bilan d'IST (<a href="https://www.ordotype.fr/ordonnances-types/ist-prise-de-risque-asymptomatique-femme-dont-rapport-oraux-et-anaux" target="_blank" rel="noopener">ordonnance</a>).</li></ul></td></tr><tr><td style="text-align: center;"><p><strong>Mycose</strong></p></td><td><ul><li data-w-id="b583c7d7-deaa-718e-af5a-484c1b87e20d" data-wf-id="[&quot;b583c7d7-deaa-718e-af5a-484c1b87e20d&quot;]" data-automation-id="dyn-item-diagnostics-input">Prurit +++,</li><li data-w-id="1090e50a-ea74-3083-e03c-b3ef66adb92b" data-wf-id="[&quot;1090e50a-ea74-3083-e03c-b3ef66adb92b&quot;]" data-automation-id="dyn-item-diagnostics-input">Leucorrh&eacute;es blanches, grumeleuses,</li><li data-w-id="87a71afe-d97a-7414-b496-356ae4d99764" data-wf-id="[&quot;87a71afe-d97a-7414-b496-356ae4d99764&quot;]" data-automation-id="dyn-item-diagnostics-input">Traitement par antifongique topique (<a href="https://www.ordotype.fr/ordonnances-types/candidose-geniale-vulvovaginite" target="_blank" rel="noopener">ordonnance</a>),</li><li data-w-id="bc2cc31a-dd25-1259-4aef-fd216f2c14d1" data-wf-id="[&quot;bc2cc31a-dd25-1259-4aef-fd216f2c14d1&quot;]" data-automation-id="dyn-item-diagnostics-input">Pas besoin de traiter le partenaire en l'absence de sympt&ocirc;mes,</li><li data-w-id="6cd7d9a2-708a-186a-611f-23d20cfd4576" data-wf-id="[&quot;6cd7d9a2-708a-186a-611f-23d20cfd4576&quot;]" data-automation-id="dyn-item-diagnostics-input">En cas de r&eacute;cidive fr&eacute;quentes :<ul><li data-w-id="048421f7-8e08-96b9-345a-9166344fc706" data-wf-id="[&quot;048421f7-8e08-96b9-345a-9166344fc706&quot;]" data-automation-id="dyn-item-diagnostics-input">Rechercher un facteur favorisant,</li><li data-w-id="a6633d1c-dbf3-2480-ad82-0044ece97fe5" data-wf-id="[&quot;a6633d1c-dbf3-2480-ad82-0044ece97fe5&quot;]" data-automation-id="dyn-item-diagnostics-input">Envisager un traitement au long cours.&nbsp;</li></ul></li></ul></td></tr><tr><td style="text-align: center;"><p><strong>Vaginose bact&eacute;rienne</strong></p></td><td><ul><li data-w-id="38cc841c-a098-8eb3-2c51-6788ff7aa3e1" data-wf-id="[&quot;38cc841c-a098-8eb3-2c51-6788ff7aa3e1&quot;]" data-automation-id="dyn-item-diagnostics-input">Pertes grises peu abondantes et malodorantes,</li><li data-w-id="da5224c0-5b0e-46d8-edc1-e6db440b2c94" data-wf-id="[&quot;da5224c0-5b0e-46d8-edc1-e6db440b2c94&quot;]" data-automation-id="dyn-item-diagnostics-input">Score de Nugent &eacute;lev&eacute; sur le pr&eacute;l&egrave;vement vaginal,</li><li data-w-id="a64c9fdd-f9b6-7578-8d6b-f61f4eb67d31" data-wf-id="[&quot;a64c9fdd-f9b6-7578-8d6b-f61f4eb67d31&quot;]" data-automation-id="dyn-item-diagnostics-input">Traitement par m&eacute;tronidazole (<a href="/ordonnances-types/traitement-vaginose-bacterienne" target="_blank" rel="noopener">ordonnance</a>),</li><li data-w-id="abf769a1-9ae7-439b-26ff-c8dfc3589fd0" data-wf-id="[&quot;abf769a1-9ae7-439b-26ff-c8dfc3589fd0&quot;]" data-automation-id="dyn-item-diagnostics-input">Traitement du partenaire inutile.</li></ul></td></tr><tr><td><p style="text-align: center;"><strong>Autres</strong></p></td><td><ul><li data-w-id="f9e9d865-e601-ca5b-ed91-870ebc55161a" data-wf-id="[&quot;f9e9d865-e601-ca5b-ed91-870ebc55161a&quot;]" data-automation-id="dyn-item-diagnostics-input"><strong>IST</strong> (<a href="https://www.ordotype.fr/pathologies/infections-sexuellement-transmissibles-ist-mst" target="_blank" rel="noopener">voir la fiche</a>),</li><li data-w-id="3fb4ad5b-5c5a-42ca-e6b9-907161dc21f7" data-wf-id="[&quot;3fb4ad5b-5c5a-42ca-e6b9-907161dc21f7&quot;]" data-automation-id="dyn-item-diagnostics-input">Corps &eacute;tranger intravaginal,</li><li data-w-id="9d8f44f9-d793-ba3b-4199-71b092660e3b" data-wf-id="[&quot;9d8f44f9-d793-ba3b-4199-71b092660e3b&quot;]" data-automation-id="dyn-item-diagnostics-input">N&eacute;oplasie,</li><li data-w-id="35954b04-7e0c-6dfd-f85b-e14e9561e0a6" data-wf-id="[&quot;35954b04-7e0c-6dfd-f85b-e14e9561e0a6&quot;]" data-automation-id="dyn-item-diagnostics-input">Atrophie par carence hormonale (femme m&eacute;nopaus&eacute;e),</li><li data-w-id="35954b04-7e0c-6dfd-f85b-e14e9561e0a6" data-wf-id="[&quot;35954b04-7e0c-6dfd-f85b-e14e9561e0a6&quot;]" data-automation-id="dyn-item-diagnostics-input">Jeune fille :<ul><li data-w-id="35954b04-7e0c-6dfd-f85b-e14e9561e0a6" data-wf-id="[&quot;35954b04-7e0c-6dfd-f85b-e14e9561e0a6&quot;]" data-automation-id="dyn-item-diagnostics-input">Vulvovaginite &agrave; germes banals (<em>S. pyogenes</em>),</li><li data-w-id="35954b04-7e0c-6dfd-f85b-e14e9561e0a6" data-wf-id="[&quot;35954b04-7e0c-6dfd-f85b-e14e9561e0a6&quot;]" data-automation-id="dyn-item-diagnostics-input">Oxyurose,</li><li data-w-id="35954b04-7e0c-6dfd-f85b-e14e9561e0a6" data-wf-id="[&quot;35954b04-7e0c-6dfd-f85b-e14e9561e0a6&quot;]" data-automation-id="dyn-item-diagnostics-input">Corps &eacute;tranger intravaginal</li></ul></li></ul></td></tr></tbody></table><p>&nbsp;</p><table border="1" cellpadding="5"><caption>Tableau 2 - Infection g&eacute;nitales hautes (hors post-partum)</caption><tbody><tr><th colspan="2"><strong data-w-id="238f8bbb-f0a4-3b9b-1497-50ad7b1a4c8a" data-wf-id="[&quot;238f8bbb-f0a4-3b9b-1497-50ad7b1a4c8a&quot;]" data-automation-id="dyn-item-diagnostics-input">Infections g&eacute;nitales hautes</strong></th></tr><tr><td style="background-color: #bef2d3; text-align: center;" colspan="2"><strong>G&eacute;n&eacute;ralit&eacute;s</strong></td></tr><tr><td><p style="text-align: center;"><strong>Principaux germes</strong></p></td><td><ul><li data-w-id="0e1c9bdc-bd7e-1d30-c83d-3b5073ab21fb" data-wf-id="[&quot;0e1c9bdc-bd7e-1d30-c83d-3b5073ab21fb&quot;]" data-automation-id="dyn-item-diagnostics-input">Germes des IST,</li><li data-w-id="d0fe7efa-2182-aab1-a7e5-ade6455b0e0d" data-wf-id="[&quot;d0fe7efa-2182-aab1-a7e5-ade6455b0e0d&quot;]" data-automation-id="dyn-item-diagnostics-input">Germes opportunistes issus de la flore vaginale,</li><li data-w-id="14f24e6e-b32b-ea7b-eaca-712044ed3872" data-wf-id="[&quot;14f24e6e-b32b-ea7b-eaca-712044ed3872&quot;]" data-automation-id="dyn-item-diagnostics-input">Exceptionnellement : tuberculose ou bilharziose.</li></ul></td></tr><tr><td style="background-color: #bef2d3; text-align: center;" colspan="2"><strong>Diagnostic positif</strong></td></tr><tr><td style="text-align: center;"><p><strong>Clinique</strong></p></td><td><ul><li data-w-id="80079081-40a8-559b-3944-d528949fc393" data-wf-id="[&quot;80079081-40a8-559b-3944-d528949fc393&quot;]" data-automation-id="dyn-item-diagnostics-input">Douleurs pelviennes / dyspareunies,</li><li data-w-id="741ca1e2-0460-a43a-cbaa-dcb341b2bd7d" data-wf-id="[&quot;741ca1e2-0460-a43a-cbaa-dcb341b2bd7d&quot;]" data-automation-id="dyn-item-diagnostics-input">Leucorrh&eacute;es pathologiques,</li><li data-w-id="9c51f569-a6b5-903d-e236-82f1598771a5" data-wf-id="[&quot;9c51f569-a6b5-903d-e236-82f1598771a5&quot;]" data-automation-id="dyn-item-diagnostics-input">Douleurs &agrave; la mobilisation ut&eacute;rine au toucher vaginal,</li><li data-w-id="0ce031d1-5abe-68b2-b56a-7f831e58c83e" data-wf-id="[&quot;0ce031d1-5abe-68b2-b56a-7f831e58c83e&quot;]" data-automation-id="dyn-item-diagnostics-input">+/- M&eacute;trorragies,</li><li data-w-id="295597d2-fcd7-6375-ead5-cd6a3ad8b41c" data-wf-id="[&quot;295597d2-fcd7-6375-ead5-cd6a3ad8b41c&quot;]" data-automation-id="dyn-item-diagnostics-input">+/- Douleurs dans les culs-de-sac vaginaux,</li><li data-w-id="46e0ba4b-05ba-5850-7825-1470b52d6ca0" data-wf-id="[&quot;46e0ba4b-05ba-5850-7825-1470b52d6ca0&quot;]" data-automation-id="dyn-item-diagnostics-input">+&nbsp;/- Signes fonctionnels urinaires,</li><li data-w-id="921b72e4-cb2e-67be-f74e-3d8755ec2dd6" data-wf-id="[&quot;921b72e4-cb2e-67be-f74e-3d8755ec2dd6&quot;]" data-automation-id="dyn-item-diagnostics-input">Absence de signes g&eacute;n&eacute;raux ou d'irritation p&eacute;riton&eacute;ales, dans les formes non compliqu&eacute;es,</li><li data-w-id="eb601134-f092-3c3e-59ca-7509c6ec74c3" data-wf-id="[&quot;eb601134-f092-3c3e-59ca-7509c6ec74c3&quot;]" data-automation-id="dyn-item-diagnostics-input">Absence de d&eacute;fense ou de contracture (m&ecirc;me si des douleurs abdominales peuvent exister, doivent faire &eacute;voquer une complication).</li></ul></td></tr><tr><td style="text-align: center;"><p><strong>Paraclinique</strong></p></td><td><ul><li data-w-id="de86e4ed-fab0-d5de-4f58-96d6abaf55da" data-wf-id="[&quot;de86e4ed-fab0-d5de-4f58-96d6abaf55da&quot;]" data-automation-id="dyn-item-diagnostics-input">Biologiques (<a href="https://www.ordotype.fr/ordonnances-types/prelevements-endocervical-infections-genitales-hautes" target="_blank" rel="noopener">ordonnance</a>) :<ul><li data-w-id="7fa2af8a-89db-86a7-f913-ae3a3584a97a" data-wf-id="[&quot;7fa2af8a-89db-86a7-f913-ae3a3584a97a&quot;]" data-automation-id="dyn-item-diagnostics-input">NFS, CRP : normaux en cas de forme non compliqu&eacute;e,</li><li data-w-id="e9431900-b93d-cb6c-aa3d-67f242fa50ed" data-wf-id="[&quot;e9431900-b93d-cb6c-aa3d-67f242fa50ed&quot;]" data-automation-id="dyn-item-diagnostics-input">Beta-HCG,</li><li data-w-id="4beac824-face-4491-dc0e-bbdfa85b090a" data-wf-id="[&quot;4beac824-face-4491-dc0e-bbdfa85b090a&quot;]" data-automation-id="dyn-item-diagnostics-input">ECBU,</li><li data-w-id="f5d70ba3-2b69-45fb-cdb9-60c0e20780ed" data-wf-id="[&quot;f5d70ba3-2b69-45fb-cdb9-60c0e20780ed&quot;]" data-automation-id="dyn-item-diagnostics-input">PCR Chlamydiae, gonocoque, mycoplasmes,</li><li data-w-id="30a44a84-cb48-a70b-655d-89054a0c49b6" data-wf-id="[&quot;30a44a84-cb48-a70b-655d-89054a0c49b6&quot;]" data-automation-id="dyn-item-diagnostics-input">Pr&eacute;l&egrave;vement endocervical en cas de suspicion d'infection g&eacute;nitale haute (auto-pr&eacute;l&egrave;vement vaginal en 2<sup>&egrave;me</sup> choix, si pr&eacute;l&egrave;vement guid&eacute; par sp&eacute;culum impossible),</li><li data-w-id="f7cae078-9277-ad60-ab54-558041ea7717" data-wf-id="[&quot;f7cae078-9277-ad60-ab54-558041ea7717&quot;]" data-automation-id="dyn-item-diagnostics-input">Mise en culture d'un &eacute;ventuel st&eacute;rilet.</li></ul></li><li data-w-id="a55639d7-1d3a-e063-c11e-691249cb8030" data-wf-id="[&quot;a55639d7-1d3a-e063-c11e-691249cb8030&quot;]" data-automation-id="dyn-item-diagnostics-input">Echographie pelvienne (<a href="https://www.ordotype.fr/ordonnances-types/echographie-infection-genitale-haute" target="_blank" rel="noopener">ordonnance</a>) :<ul><li data-w-id="a55639d7-1d3a-e063-c11e-691249cb8030" data-wf-id="[&quot;a55639d7-1d3a-e063-c11e-691249cb8030&quot;]" data-automation-id="dyn-item-diagnostics-input">recherche de complications ou</li><li data-w-id="a55639d7-1d3a-e063-c11e-691249cb8030" data-wf-id="[&quot;a55639d7-1d3a-e063-c11e-691249cb8030&quot;]" data-automation-id="dyn-item-diagnostics-input">de diagnostic diff&eacute;rentiel.&nbsp;</li></ul></li><li data-w-id="76d8b577-fd7b-6b34-7ac1-8997931ec7f0" data-wf-id="[&quot;76d8b577-fd7b-6b34-7ac1-8997931ec7f0&quot;]" data-automation-id="dyn-item-diagnostics-input">En cas de doute avec un diagnostic diff&eacute;rentiel : TDM, IRM voir coelioscopie.</li></ul></td></tr><tr><td style="text-align: center;"><p><strong>Complications</strong></p></td><td><ul><li data-w-id="3f45abd5-0707-2a86-ddd7-ad2bccb07e39" data-wf-id="[&quot;3f45abd5-0707-2a86-ddd7-ad2bccb07e39&quot;]" data-automation-id="dyn-item-diagnostics-input">Aigu&euml;s <strong>(Hospitalisation pour pr&eacute;l&egrave;vements chirurgicaux ou &eacute;choguid&eacute;s)</strong> :<ul><li data-w-id="3f8ef4b9-6a53-0ab3-49e7-7a8de49b723f" data-wf-id="[&quot;3f8ef4b9-6a53-0ab3-49e7-7a8de49b723f&quot;]" data-automation-id="dyn-item-diagnostics-input">Pelvi-p&eacute;ritonites,</li><li data-w-id="4c56446b-1d21-fb6b-a30f-7946c9a8de75" data-wf-id="[&quot;4c56446b-1d21-fb6b-a30f-7946c9a8de75&quot;]" data-automation-id="dyn-item-diagnostics-input">Abc&egrave;s pelvien.</li></ul></li><li data-w-id="5c70d4b2-8bd2-e926-5e71-b60897dba1df" data-wf-id="[&quot;5c70d4b2-8bd2-e926-5e71-b60897dba1df&quot;]" data-automation-id="dyn-item-diagnostics-input">&Agrave; long terme :<ul><li data-w-id="0572913d-5d3f-ef9c-8fb0-061a015f486f" data-wf-id="[&quot;0572913d-5d3f-ef9c-8fb0-061a015f486f&quot;]" data-automation-id="dyn-item-diagnostics-input">Infertilit&eacute;,</li><li data-w-id="720d12f4-8350-6b4e-8616-ca4aba40718f" data-wf-id="[&quot;720d12f4-8350-6b4e-8616-ca4aba40718f&quot;]" data-automation-id="dyn-item-diagnostics-input">GEU,</li><li data-w-id="5b82d2e3-196a-43ae-0040-a58fe4155174" data-wf-id="[&quot;5b82d2e3-196a-43ae-0040-a58fe4155174&quot;]" data-automation-id="dyn-item-diagnostics-input">Douleurs pelviennes chroniques.</li></ul></li></ul></td></tr><tr><td style="background-color: #bef2d3; text-align: center;" colspan="2"><strong>Traitement</strong></td></tr><tr><td style="text-align: center;"><p><strong>G&eacute;n&eacute;ralit&eacute;s</strong></p></td><td><p><strong>D&eacute;buter sans attendre les r&eacute;sultats des examens.</strong></p><ul><li data-w-id="4329d0c2-c115-1e2d-049e-18a3163b6e08" data-wf-id="[&quot;4329d0c2-c115-1e2d-049e-18a3163b6e08&quot;]" data-automation-id="dyn-item-diagnostics-input">Seules les formes non compliqu&eacute;es peuvent &ecirc;tre prises en charge en ambulatoire, les autres doivent &ecirc;tre hospitalis&eacute;es en urgence.&nbsp;</li><li data-w-id="768e4093-d65c-af54-ab02-fa77165646ca" data-wf-id="[&quot;768e4093-d65c-af54-ab02-fa77165646ca&quot;]" data-automation-id="dyn-item-diagnostics-input">Traitement de la patiente et du partenaire et protection des rapports en cas d'IST,</li><li data-w-id="0e2f2397-adba-5110-3c33-fd8a0e306f54" data-wf-id="[&quot;0e2f2397-adba-5110-3c33-fd8a0e306f54&quot;]" data-automation-id="dyn-item-diagnostics-input">Retrait d'un DIU non syst&eacute;matique mais &agrave; discuter (avis sp&eacute;cialis&eacute;),</li><li data-w-id="4d599ac2-1e27-d07d-eed9-e007530d0c6f" data-wf-id="[&quot;4d599ac2-1e27-d07d-eed9-e007530d0c6f&quot;]" data-automation-id="dyn-item-diagnostics-input">Traitement symptomatique,</li><li data-w-id="4d599ac2-1e27-d07d-eed9-e007530d0c6f" data-wf-id="[&quot;4d599ac2-1e27-d07d-eed9-e007530d0c6f&quot;]" data-automation-id="dyn-item-diagnostics-input">R&eacute;&eacute;valuation syst&eacute;matique &agrave; 3-6 mois pour v&eacute;rifier l'absence de r&eacute;cidive</li></ul></td></tr><tr><td style="text-align: center;"><strong>Forme non compliqu&eacute;e</strong></td><td><ul><li>Traitement ambulatoire possible</li><li>Hospitalisation si forme non compliqu&eacute;e interm&eacute;diaire :<ul><li>Doute diagnostique,</li><li>Sympt&ocirc;mes tr&egrave;s intenses,</li><li>Difficult&eacute; de prise des antibiotiques oraux,</li><li>&Eacute;chec d'un traitement ant&eacute;rieur,</li><li>D&eacute;tresse psychosociale.</li></ul></li><li>Antibioth&eacute;rapie (<a href="https://www.ordotype.fr/ordonnances-types/infection-genitale-haute" target="_blank" rel="noopener">ordonnance</a>) :<ul><li data-w-id="07e37eb2-173d-6d69-0182-f180c24944c2" data-wf-id="[&quot;07e37eb2-173d-6d69-0182-f180c24944c2&quot;]" data-automation-id="dyn-item-diagnostics-input">Ceftriaxone dose unique IM (<a href="https://www.ordotype.fr/ordonnances-types/ide-ceftriaxone-infection-genitale-haute" target="_blank" rel="noopener">ordonnance injection par IDE</a>), ET</li><li data-w-id="937d1e80-f46a-8495-13a8-cee8ddb954f6" data-wf-id="[&quot;937d1e80-f46a-8495-13a8-cee8ddb954f6&quot;]" data-automation-id="dyn-item-diagnostics-input">Doxycycline 10 jours, ET</li><li data-w-id="a5a86034-93af-b82f-bd6f-49b3380f64d9" data-wf-id="[&quot;a5a86034-93af-b82f-bd6f-49b3380f64d9&quot;]" data-automation-id="dyn-item-diagnostics-input">M&eacute;tronidazole 10 jours</li></ul></li><li data-w-id="a3ba6a59-0a47-17f2-5af8-9cf59cf35036" data-wf-id="[&quot;a3ba6a59-0a47-17f2-5af8-9cf59cf35036&quot;]" data-automation-id="dyn-item-diagnostics-input">Revoir obligatoirement entre 3 et 5 jours pour juger de l'&eacute;volution et v&eacute;rifier l'observance,</li><li>Retrait d'un DIU non syst&eacute;matique mais &agrave; discuter (avis sp&eacute;cialis&eacute;).</li></ul></td></tr><tr><td style="text-align: center;"><strong>Forme compliqu&eacute;e</strong></td><td><ul><li><strong>Hospitalisation en urgence</strong></li><li><strong><strong>Drainage chirurgical ou radioguid&eacute; des abc&egrave;s &gt; 3-4 cm</strong></strong></li><li><strong><strong>Antibioth&eacute;rapie :</strong></strong><ul><li data-w-id="07e37eb2-173d-6d69-0182-f180c24944c2" data-wf-id="[&quot;07e37eb2-173d-6d69-0182-f180c24944c2&quot;]" data-automation-id="dyn-item-diagnostics-input">Ceftriaxone 1-2 g/j (2 g si signes de gravt&eacute; ou poids &gt; 80kg) IV, jusqu'&agrave; am&eacute;lioration, ET</li><li data-w-id="937d1e80-f46a-8495-13a8-cee8ddb954f6" data-wf-id="[&quot;937d1e80-f46a-8495-13a8-cee8ddb954f6&quot;]" data-automation-id="dyn-item-diagnostics-input">Doxycycline 14 jours, ET</li><li data-w-id="a5a86034-93af-b82f-bd6f-49b3380f64d9" data-wf-id="[&quot;a5a86034-93af-b82f-bd6f-49b3380f64d9&quot;]" data-automation-id="dyn-item-diagnostics-input">M&eacute;tronidazole 14 jours</li></ul></li><li data-w-id="a3ba6a59-0a47-17f2-5af8-9cf59cf35036" data-wf-id="[&quot;a3ba6a59-0a47-17f2-5af8-9cf59cf35036&quot;]" data-automation-id="dyn-item-diagnostics-input">Retrait d'un DIU.</li></ul></td></tr></tbody></table>‍

<table border="1" cellpadding="5"><caption>Tableau 1 - Leucorrh&eacute;es</caption><tbody><tr><th colspan="2">Leucorrh&eacute;es physiologiques</th></tr><tr><td colspan="2"><ul><li data-w-id="995f8c47-2faa-ccf5-0e7f-be61d7fe7537" data-wf-id="[&quot;995f8c47-2faa-ccf5-0e7f-be61d7fe7537&quot;]" data-automation-id="dyn-item-diagnostics-input">Laiteuses ou translucides, peu abondantes, augmentant en p&eacute;riode pr&eacute;menstruelle,</li><li data-w-id="5e54d327-0b41-b666-419e-bcad6e2854b4" data-wf-id="[&quot;5e54d327-0b41-b666-419e-bcad6e2854b4&quot;]" data-automation-id="dyn-item-diagnostics-input">Inodores, non irritantes,</li><li data-w-id="f017be03-afb6-4731-cf92-070752c591c5" data-wf-id="[&quot;f017be03-afb6-4731-cf92-070752c591c5&quot;]" data-automation-id="dyn-item-diagnostics-input">Ne contiennent pas de polynucl&eacute;aire,</li><li data-w-id="c2980f4d-e5a1-8d1c-5a7e-fb4ed0e6191b" data-wf-id="[&quot;c2980f4d-e5a1-8d1c-5a7e-fb4ed0e6191b&quot;]" data-automation-id="dyn-item-diagnostics-input">Flore dominante = bacille de D&ouml;derlein.</li></ul></td></tr><tr><th colspan="2">Leucorrh&eacute;es pathologiques</th></tr><tr><td style="background-color: #bef2d3; text-align: center;" colspan="2"><strong>Diagnostic</strong></td></tr><tr><td style="text-align: center;"><strong>Clinique</strong></td><td><p>Signes &eacute;vocateurs d'une infection g&eacute;nitale :</p><ul><li data-w-id="a6cac40d-6336-44b2-5cb8-9fbee741b2c7" data-wf-id="[&quot;a6cac40d-6336-44b2-5cb8-9fbee741b2c7&quot;]" data-automation-id="dyn-item-diagnostics-input">Leucorrh&eacute;es malodorantes,</li><li data-w-id="88b0edd3-50d6-9cd1-834c-ea3909f128be" data-wf-id="[&quot;88b0edd3-50d6-9cd1-834c-ea3909f128be&quot;]" data-automation-id="dyn-item-diagnostics-input">Prurit ou br&ucirc;lures,</li><li data-w-id="c92c5a05-eec3-d1e0-fac2-4b69c272ed1f" data-wf-id="[&quot;c92c5a05-eec3-d1e0-fac2-4b69c272ed1f&quot;]" data-automation-id="dyn-item-diagnostics-input">M&eacute;trorragies, douleurs pelviennes ou signes g&eacute;n&eacute;raux associ&eacute;es (orientent vers une cervicite ou une infection g&eacute;nitale haute),</li><li data-w-id="0704fd2d-e4ef-9c0b-2b47-4ac572db9677" data-wf-id="[&quot;0704fd2d-e4ef-9c0b-2b47-4ac572db9677&quot;]" data-automation-id="dyn-item-diagnostics-input">Signes fonctionnels urinaires associ&eacute;s,</li><li data-w-id="b7a114ad-9316-6770-8ba1-6057686baa35" data-wf-id="[&quot;b7a114ad-9316-6770-8ba1-6057686baa35&quot;]" data-automation-id="dyn-item-diagnostics-input">Inflammation vulvaire, v&eacute;sicules, ulc&eacute;rations.</li></ul></td></tr><tr><td style="text-align: center;"><strong>Paraclinique</strong><br /><strong> (hors infection g&eacute;nitale haute)</strong></td><td><p>Pr&eacute;l&egrave;vement vaginal (<a href="https://www.ordotype.fr/ordonnances-types/prelevements-microbiologiques-leucorrhees" target="_blank" rel="noopener">ordonnance</a>) :</p><ul><li data-w-id="1234bc9b-cf6f-122d-bd3f-89adf389b540" data-wf-id="[&quot;1234bc9b-cf6f-122d-bd3f-89adf389b540&quot;]" data-automation-id="dyn-item-diagnostics-input">Examen direct &agrave; l'&eacute;tat frais,</li><li data-w-id="8c904b5b-19da-f993-64cc-38634d747dfe" data-wf-id="[&quot;8c904b5b-19da-f993-64cc-38634d747dfe&quot;]" data-automation-id="dyn-item-diagnostics-input">Analyse mycologique,</li><li data-w-id="62d71766-0721-9d0d-9ccb-bd65bf3d497a" data-wf-id="[&quot;62d71766-0721-9d0d-9ccb-bd65bf3d497a&quot;]" data-automation-id="dyn-item-diagnostics-input">Analyse bact&eacute;riologique,</li><li data-w-id="265bc0fd-d721-79a3-0cae-19cf07bd7d20" data-wf-id="[&quot;265bc0fd-d721-79a3-0cae-19cf07bd7d20&quot;]" data-automation-id="dyn-item-diagnostics-input">PCR Chlamydiae, gonocoque, mycoplasmes.</li></ul></td></tr><tr><td style="background-color: #def3e5; text-align: center;" colspan="2"><strong>Principales &eacute;tiologies</strong></td></tr><tr><td style="text-align: center;"><p data-w-id="4b6ddf45-4b67-5a9a-3f87-44ab1bee556e" data-wf-id="[&quot;4b6ddf45-4b67-5a9a-3f87-44ab1bee556e&quot;]" data-automation-id="dyn-item-diagnostics-input"><strong>Trichomonas</strong></p></td><td><ul><li data-w-id="016c4151-8b53-d2c1-1d7b-d12261ef896c" data-wf-id="[&quot;016c4151-8b53-d2c1-1d7b-d12261ef896c&quot;]" data-automation-id="dyn-item-diagnostics-input">Leucorrh&eacute;es verd&acirc;tres et naus&eacute;abondes,</li><li data-w-id="b8dfce5d-4f91-4330-434f-448ef0c930d9" data-wf-id="[&quot;b8dfce5d-4f91-4330-434f-448ef0c930d9&quot;]" data-automation-id="dyn-item-diagnostics-input">Traitement par m&eacute;tronidazole (<a href="https://www.ordotype.fr/ordonnances-types/traitement-vaginose-bacterienne" target="_blank" rel="noopener">ordonnance</a>),</li><li data-w-id="76be031d-1d0e-8b3a-cd7a-f32413a48bc8" data-wf-id="[&quot;76be031d-1d0e-8b3a-cd7a-f32413a48bc8&quot;]" data-automation-id="dyn-item-diagnostics-input">Traiter les partenaires sexuels,</li><li data-w-id="89bf73bd-31c4-5e8f-c3b1-1150e17cf508" data-wf-id="[&quot;89bf73bd-31c4-5e8f-c3b1-1150e17cf508&quot;]" data-automation-id="dyn-item-diagnostics-input">Bilan d'IST (<a href="https://www.ordotype.fr/ordonnances-types/ist-prise-de-risque-asymptomatique-femme-dont-rapport-oraux-et-anaux" target="_blank" rel="noopener">ordonnance</a>).</li></ul></td></tr><tr><td style="text-align: center;"><p><strong>Mycose</strong></p></td><td><ul><li data-w-id="b583c7d7-deaa-718e-af5a-484c1b87e20d" data-wf-id="[&quot;b583c7d7-deaa-718e-af5a-484c1b87e20d&quot;]" data-automation-id="dyn-item-diagnostics-input">Prurit +++,</li><li data-w-id="1090e50a-ea74-3083-e03c-b3ef66adb92b" data-wf-id="[&quot;1090e50a-ea74-3083-e03c-b3ef66adb92b&quot;]" data-automation-id="dyn-item-diagnostics-input">Leucorrh&eacute;es blanches, grumeleuses,</li><li data-w-id="87a71afe-d97a-7414-b496-356ae4d99764" data-wf-id="[&quot;87a71afe-d97a-7414-b496-356ae4d99764&quot;]" data-automation-id="dyn-item-diagnostics-input">Traitement par antifongique topique (<a href="https://www.ordotype.fr/ordonnances-types/candidose-geniale-vulvovaginite" target="_blank" rel="noopener">ordonnance</a>),</li><li data-w-id="bc2cc31a-dd25-1259-4aef-fd216f2c14d1" data-wf-id="[&quot;bc2cc31a-dd25-1259-4aef-fd216f2c14d1&quot;]" data-automation-id="dyn-item-diagnostics-input">Pas besoin de traiter le partenaire en l'absence de sympt&ocirc;mes,</li><li data-w-id="6cd7d9a2-708a-186a-611f-23d20cfd4576" data-wf-id="[&quot;6cd7d9a2-708a-186a-611f-23d20cfd4576&quot;]" data-automation-id="dyn-item-diagnostics-input">En cas de r&eacute;cidive fr&eacute;quentes :<ul><li data-w-id="048421f7-8e08-96b9-345a-9166344fc706" data-wf-id="[&quot;048421f7-8e08-96b9-345a-9166344fc706&quot;]" data-automation-id="dyn-item-diagnostics-input">Rechercher un facteur favorisant,</li><li data-w-id="a6633d1c-dbf3-2480-ad82-0044ece97fe5" data-wf-id="[&quot;a6633d1c-dbf3-2480-ad82-0044ece97fe5&quot;]" data-automation-id="dyn-item-diagnostics-input">Envisager un traitement au long cours.&nbsp;</li></ul></li></ul></td></tr><tr><td style="text-align: center;"><p><strong>Vaginose bact&eacute;rienne</strong></p></td><td><ul><li data-w-id="38cc841c-a098-8eb3-2c51-6788ff7aa3e1" data-wf-id="[&quot;38cc841c-a098-8eb3-2c51-6788ff7aa3e1&quot;]" data-automation-id="dyn-item-diagnostics-input">Pertes grises peu abondantes et malodorantes,</li><li data-w-id="da5224c0-5b0e-46d8-edc1-e6db440b2c94" data-wf-id="[&quot;da5224c0-5b0e-46d8-edc1-e6db440b2c94&quot;]" data-automation-id="dyn-item-diagnostics-input">Score de Nugent &eacute;lev&eacute; sur le pr&eacute;l&egrave;vement vaginal,</li><li data-w-id="a64c9fdd-f9b6-7578-8d6b-f61f4eb67d31" data-wf-id="[&quot;a64c9fdd-f9b6-7578-8d6b-f61f4eb67d31&quot;]" data-automation-id="dyn-item-diagnostics-input">Traitement par m&eacute;tronidazole (<a href="/ordonnances-types/traitement-vaginose-bacterienne" target="_blank" rel="noopener">ordonnance</a>),</li><li data-w-id="abf769a1-9ae7-439b-26ff-c8dfc3589fd0" data-wf-id="[&quot;abf769a1-9ae7-439b-26ff-c8dfc3589fd0&quot;]" data-automation-id="dyn-item-diagnostics-input">Traitement du partenaire inutile.</li></ul></td></tr><tr><td><p style="text-align: center;"><strong>Autres</strong></p></td><td><ul><li data-w-id="f9e9d865-e601-ca5b-ed91-870ebc55161a" data-wf-id="[&quot;f9e9d865-e601-ca5b-ed91-870ebc55161a&quot;]" data-automation-id="dyn-item-diagnostics-input"><strong>IST</strong> (<a href="https://www.ordotype.fr/pathologies/infections-sexuellement-transmissibles-ist-mst" target="_blank" rel="noopener">voir la fiche</a>),</li><li data-w-id="3fb4ad5b-5c5a-42ca-e6b9-907161dc21f7" data-wf-id="[&quot;3fb4ad5b-5c5a-42ca-e6b9-907161dc21f7&quot;]" data-automation-id="dyn-item-diagnostics-input">Corps &eacute;tranger intravaginal,</li><li data-w-id="9d8f44f9-d793-ba3b-4199-71b092660e3b" data-wf-id="[&quot;9d8f44f9-d793-ba3b-4199-71b092660e3b&quot;]" data-automation-id="dyn-item-diagnostics-input">N&eacute;oplasie,</li><li data-w-id="35954b04-7e0c-6dfd-f85b-e14e9561e0a6" data-wf-id="[&quot;35954b04-7e0c-6dfd-f85b-e14e9561e0a6&quot;]" data-automation-id="dyn-item-diagnostics-input">Atrophie par carence hormonale (femme m&eacute;nopaus&eacute;e),</li><li data-w-id="35954b04-7e0c-6dfd-f85b-e14e9561e0a6" data-wf-id="[&quot;35954b04-7e0c-6dfd-f85b-e14e9561e0a6&quot;]" data-automation-id="dyn-item-diagnostics-input">Jeune fille :<ul><li data-w-id="35954b04-7e0c-6dfd-f85b-e14e9561e0a6" data-wf-id="[&quot;35954b04-7e0c-6dfd-f85b-e14e9561e0a6&quot;]" data-automation-id="dyn-item-diagnostics-input">Vulvovaginite &agrave; germes banals (<em>S. pyogenes</em>),</li><li data-w-id="35954b04-7e0c-6dfd-f85b-e14e9561e0a6" data-wf-id="[&quot;35954b04-7e0c-6dfd-f85b-e14e9561e0a6&quot;]" data-automation-id="dyn-item-diagnostics-input">Oxyurose,</li><li data-w-id="35954b04-7e0c-6dfd-f85b-e14e9561e0a6" data-wf-id="[&quot;35954b04-7e0c-6dfd-f85b-e14e9561e0a6&quot;]" data-automation-id="dyn-item-diagnostics-input">Corps &eacute;tranger intravaginal</li></ul></li></ul></td></tr></tbody></table><p>&nbsp;</p><table border="1" cellpadding="5"><caption>Tableau 2 - Infection g&eacute;nitales hautes (hors post-partum)</caption><tbody><tr><th colspan="2"><strong data-w-id="238f8bbb-f0a4-3b9b-1497-50ad7b1a4c8a" data-wf-id="[&quot;238f8bbb-f0a4-3b9b-1497-50ad7b1a4c8a&quot;]" data-automation-id="dyn-item-diagnostics-input">Infections g&eacute;nitales hautes</strong></th></tr><tr><td style="background-color: #bef2d3; text-align: center;" colspan="2"><strong>G&eacute;n&eacute;ralit&eacute;s</strong></td></tr><tr><td><p style="text-align: center;"><strong>Principaux germes</strong></p></td><td><ul><li data-w-id="0e1c9bdc-bd7e-1d30-c83d-3b5073ab21fb" data-wf-id="[&quot;0e1c9bdc-bd7e-1d30-c83d-3b5073ab21fb&quot;]" data-automation-id="dyn-item-diagnostics-input">Germes des IST,</li><li data-w-id="d0fe7efa-2182-aab1-a7e5-ade6455b0e0d" data-wf-id="[&quot;d0fe7efa-2182-aab1-a7e5-ade6455b0e0d&quot;]" data-automation-id="dyn-item-diagnostics-input">Germes opportunistes issus de la flore vaginale,</li><li data-w-id="14f24e6e-b32b-ea7b-eaca-712044ed3872" data-wf-id="[&quot;14f24e6e-b32b-ea7b-eaca-712044ed3872&quot;]" data-automation-id="dyn-item-diagnostics-input">Exceptionnellement : tuberculose ou bilharziose.</li></ul></td></tr><tr><td style="background-color: #bef2d3; text-align: center;" colspan="2"><strong>Diagnostic positif</strong></td></tr><tr><td style="text-align: center;"><p><strong>Clinique</strong></p></td><td><ul><li data-w-id="80079081-40a8-559b-3944-d528949fc393" data-wf-id="[&quot;80079081-40a8-559b-3944-d528949fc393&quot;]" data-automation-id="dyn-item-diagnostics-input">Douleurs pelviennes / dyspareunies,</li><li data-w-id="741ca1e2-0460-a43a-cbaa-dcb341b2bd7d" data-wf-id="[&quot;741ca1e2-0460-a43a-cbaa-dcb341b2bd7d&quot;]" data-automation-id="dyn-item-diagnostics-input">Leucorrh&eacute;es pathologiques,</li><li data-w-id="9c51f569-a6b5-903d-e236-82f1598771a5" data-wf-id="[&quot;9c51f569-a6b5-903d-e236-82f1598771a5&quot;]" data-automation-id="dyn-item-diagnostics-input">Douleurs &agrave; la mobilisation ut&eacute;rine au toucher vaginal,</li><li data-w-id="0ce031d1-5abe-68b2-b56a-7f831e58c83e" data-wf-id="[&quot;0ce031d1-5abe-68b2-b56a-7f831e58c83e&quot;]" data-automation-id="dyn-item-diagnostics-input">+/- M&eacute;trorragies,</li><li data-w-id="295597d2-fcd7-6375-ead5-cd6a3ad8b41c" data-wf-id="[&quot;295597d2-fcd7-6375-ead5-cd6a3ad8b41c&quot;]" data-automation-id="dyn-item-diagnostics-input">+/- Douleurs dans les culs-de-sac vaginaux,</li><li data-w-id="46e0ba4b-05ba-5850-7825-1470b52d6ca0" data-wf-id="[&quot;46e0ba4b-05ba-5850-7825-1470b52d6ca0&quot;]" data-automation-id="dyn-item-diagnostics-input">+&nbsp;/- Signes fonctionnels urinaires,</li><li data-w-id="921b72e4-cb2e-67be-f74e-3d8755ec2dd6" data-wf-id="[&quot;921b72e4-cb2e-67be-f74e-3d8755ec2dd6&quot;]" data-automation-id="dyn-item-diagnostics-input">Absence de signes g&eacute;n&eacute;raux ou d'irritation p&eacute;riton&eacute;ales, dans les formes non compliqu&eacute;es,</li><li data-w-id="eb601134-f092-3c3e-59ca-7509c6ec74c3" data-wf-id="[&quot;eb601134-f092-3c3e-59ca-7509c6ec74c3&quot;]" data-automation-id="dyn-item-diagnostics-input">Absence de d&eacute;fense ou de contracture (m&ecirc;me si des douleurs abdominales peuvent exister, doivent faire &eacute;voquer une complication).</li></ul></td></tr><tr><td style="text-align: center;"><p><strong>Paraclinique</strong></p></td><td><ul><li data-w-id="de86e4ed-fab0-d5de-4f58-96d6abaf55da" data-wf-id="[&quot;de86e4ed-fab0-d5de-4f58-96d6abaf55da&quot;]" data-automation-id="dyn-item-diagnostics-input">Biologiques (<a href="https://www.ordotype.fr/ordonnances-types/prelevements-endocervical-infections-genitales-hautes" target="_blank" rel="noopener">ordonnance</a>) :<ul><li data-w-id="7fa2af8a-89db-86a7-f913-ae3a3584a97a" data-wf-id="[&quot;7fa2af8a-89db-86a7-f913-ae3a3584a97a&quot;]" data-automation-id="dyn-item-diagnostics-input">NFS, CRP : normaux en cas de forme non compliqu&eacute;e,</li><li data-w-id="e9431900-b93d-cb6c-aa3d-67f242fa50ed" data-wf-id="[&quot;e9431900-b93d-cb6c-aa3d-67f242fa50ed&quot;]" data-automation-id="dyn-item-diagnostics-input">Beta-HCG,</li><li data-w-id="4beac824-face-4491-dc0e-bbdfa85b090a" data-wf-id="[&quot;4beac824-face-4491-dc0e-bbdfa85b090a&quot;]" data-automation-id="dyn-item-diagnostics-input">ECBU,</li><li data-w-id="f5d70ba3-2b69-45fb-cdb9-60c0e20780ed" data-wf-id="[&quot;f5d70ba3-2b69-45fb-cdb9-60c0e20780ed&quot;]" data-automation-id="dyn-item-diagnostics-input">PCR Chlamydiae, gonocoque, mycoplasmes,</li><li data-w-id="30a44a84-cb48-a70b-655d-89054a0c49b6" data-wf-id="[&quot;30a44a84-cb48-a70b-655d-89054a0c49b6&quot;]" data-automation-id="dyn-item-diagnostics-input">Pr&eacute;l&egrave;vement endocervical en cas de suspicion d'infection g&eacute;nitale haute (auto-pr&eacute;l&egrave;vement vaginal en 2<sup>&egrave;me</sup> choix, si pr&eacute;l&egrave;vement guid&eacute; par sp&eacute;culum impossible),</li><li data-w-id="f7cae078-9277-ad60-ab54-558041ea7717" data-wf-id="[&quot;f7cae078-9277-ad60-ab54-558041ea7717&quot;]" data-automation-id="dyn-item-diagnostics-input">Mise en culture d'un &eacute;ventuel st&eacute;rilet.</li></ul></li><li data-w-id="a55639d7-1d3a-e063-c11e-691249cb8030" data-wf-id="[&quot;a55639d7-1d3a-e063-c11e-691249cb8030&quot;]" data-automation-id="dyn-item-diagnostics-input">Echographie pelvienne (<a href="https://www.ordotype.fr/ordonnances-types/echographie-infection-genitale-haute" target="_blank" rel="noopener">ordonnance</a>) :<ul><li data-w-id="a55639d7-1d3a-e063-c11e-691249cb8030" data-wf-id="[&quot;a55639d7-1d3a-e063-c11e-691249cb8030&quot;]" data-automation-id="dyn-item-diagnostics-input">recherche de complications ou</li><li data-w-id="a55639d7-1d3a-e063-c11e-691249cb8030" data-wf-id="[&quot;a55639d7-1d3a-e063-c11e-691249cb8030&quot;]" data-automation-id="dyn-item-diagnostics-input">de diagnostic diff&eacute;rentiel.&nbsp;</li></ul></li><li data-w-id="76d8b577-fd7b-6b34-7ac1-8997931ec7f0" data-wf-id="[&quot;76d8b577-fd7b-6b34-7ac1-8997931ec7f0&quot;]" data-automation-id="dyn-item-diagnostics-input">En cas de doute avec un diagnostic diff&eacute;rentiel : TDM, IRM voir coelioscopie.</li></ul></td></tr><tr><td style="text-align: center;"><p><strong>Complications</strong></p></td><td><ul><li data-w-id="3f45abd5-0707-2a86-ddd7-ad2bccb07e39" data-wf-id="[&quot;3f45abd5-0707-2a86-ddd7-ad2bccb07e39&quot;]" data-automation-id="dyn-item-diagnostics-input">Aigu&euml;s <strong>(Hospitalisation pour pr&eacute;l&egrave;vements chirurgicaux ou &eacute;choguid&eacute;s)</strong> :<ul><li data-w-id="3f8ef4b9-6a53-0ab3-49e7-7a8de49b723f" data-wf-id="[&quot;3f8ef4b9-6a53-0ab3-49e7-7a8de49b723f&quot;]" data-automation-id="dyn-item-diagnostics-input">Pelvi-p&eacute;ritonites,</li><li data-w-id="4c56446b-1d21-fb6b-a30f-7946c9a8de75" data-wf-id="[&quot;4c56446b-1d21-fb6b-a30f-7946c9a8de75&quot;]" data-automation-id="dyn-item-diagnostics-input">Abc&egrave;s pelvien.</li></ul></li><li data-w-id="5c70d4b2-8bd2-e926-5e71-b60897dba1df" data-wf-id="[&quot;5c70d4b2-8bd2-e926-5e71-b60897dba1df&quot;]" data-automation-id="dyn-item-diagnostics-input">&Agrave; long terme :<ul><li data-w-id="0572913d-5d3f-ef9c-8fb0-061a015f486f" data-wf-id="[&quot;0572913d-5d3f-ef9c-8fb0-061a015f486f&quot;]" data-automation-id="dyn-item-diagnostics-input">Infertilit&eacute;,</li><li data-w-id="720d12f4-8350-6b4e-8616-ca4aba40718f" data-wf-id="[&quot;720d12f4-8350-6b4e-8616-ca4aba40718f&quot;]" data-automation-id="dyn-item-diagnostics-input">GEU,</li><li data-w-id="5b82d2e3-196a-43ae-0040-a58fe4155174" data-wf-id="[&quot;5b82d2e3-196a-43ae-0040-a58fe4155174&quot;]" data-automation-id="dyn-item-diagnostics-input">Douleurs pelviennes chroniques.</li></ul></li></ul></td></tr><tr><td style="background-color: #bef2d3; text-align: center;" colspan="2"><strong>Traitement</strong></td></tr><tr><td style="text-align: center;"><p><strong>G&eacute;n&eacute;ralit&eacute;s</strong></p></td><td><p><strong>D&eacute;buter sans attendre les r&eacute;sultats des examens.</strong></p><ul><li data-w-id="4329d0c2-c115-1e2d-049e-18a3163b6e08" data-wf-id="[&quot;4329d0c2-c115-1e2d-049e-18a3163b6e08&quot;]" data-automation-id="dyn-item-diagnostics-input">Seules les formes non compliqu&eacute;es peuvent &ecirc;tre prises en charge en ambulatoire, les autres doivent &ecirc;tre hospitalis&eacute;es en urgence.&nbsp;</li><li data-w-id="768e4093-d65c-af54-ab02-fa77165646ca" data-wf-id="[&quot;768e4093-d65c-af54-ab02-fa77165646ca&quot;]" data-automation-id="dyn-item-diagnostics-input">Traitement de la patiente et du partenaire et protection des rapports en cas d'IST,</li><li data-w-id="0e2f2397-adba-5110-3c33-fd8a0e306f54" data-wf-id="[&quot;0e2f2397-adba-5110-3c33-fd8a0e306f54&quot;]" data-automation-id="dyn-item-diagnostics-input">Retrait d'un DIU non syst&eacute;matique mais &agrave; discuter (avis sp&eacute;cialis&eacute;),</li><li data-w-id="4d599ac2-1e27-d07d-eed9-e007530d0c6f" data-wf-id="[&quot;4d599ac2-1e27-d07d-eed9-e007530d0c6f&quot;]" data-automation-id="dyn-item-diagnostics-input">Traitement symptomatique,</li><li data-w-id="4d599ac2-1e27-d07d-eed9-e007530d0c6f" data-wf-id="[&quot;4d599ac2-1e27-d07d-eed9-e007530d0c6f&quot;]" data-automation-id="dyn-item-diagnostics-input">R&eacute;&eacute;valuation syst&eacute;matique &agrave; 3-6 mois pour v&eacute;rifier l'absence de r&eacute;cidive</li></ul></td></tr><tr><td style="text-align: center;"><strong>Forme non compliqu&eacute;e</strong></td><td><ul><li>Traitement ambulatoire possible</li><li>Hospitalisation si forme non compliqu&eacute;e interm&eacute;diaire :<ul><li>Doute diagnostique,</li><li>Sympt&ocirc;mes tr&egrave;s intenses,</li><li>Difficult&eacute; de prise des antibiotiques oraux,</li><li>&Eacute;chec d'un traitement ant&eacute;rieur,</li><li>D&eacute;tresse psychosociale.</li></ul></li><li>Antibioth&eacute;rapie (<a href="https://www.ordotype.fr/ordonnances-types/infection-genitale-haute" target="_blank" rel="noopener">ordonnance</a>) :<ul><li data-w-id="07e37eb2-173d-6d69-0182-f180c24944c2" data-wf-id="[&quot;07e37eb2-173d-6d69-0182-f180c24944c2&quot;]" data-automation-id="dyn-item-diagnostics-input">Ceftriaxone dose unique IM (<a href="https://www.ordotype.fr/ordonnances-types/ide-ceftriaxone-infection-genitale-haute" target="_blank" rel="noopener">ordonnance injection par IDE</a>), ET</li><li data-w-id="937d1e80-f46a-8495-13a8-cee8ddb954f6" data-wf-id="[&quot;937d1e80-f46a-8495-13a8-cee8ddb954f6&quot;]" data-automation-id="dyn-item-diagnostics-input">Doxycycline 10 jours, ET</li><li data-w-id="a5a86034-93af-b82f-bd6f-49b3380f64d9" data-wf-id="[&quot;a5a86034-93af-b82f-bd6f-49b3380f64d9&quot;]" data-automation-id="dyn-item-diagnostics-input">M&eacute;tronidazole 10 jours</li></ul></li><li data-w-id="a3ba6a59-0a47-17f2-5af8-9cf59cf35036" data-wf-id="[&quot;a3ba6a59-0a47-17f2-5af8-9cf59cf35036&quot;]" data-automation-id="dyn-item-diagnostics-input">Revoir obligatoirement entre 3 et 5 jours pour juger de l'&eacute;volution et v&eacute;rifier l'observance,</li><li>Retrait d'un DIU non syst&eacute;matique mais &agrave; discuter (avis sp&eacute;cialis&eacute;).</li></ul></td></tr><tr><td style="text-align: center;"><strong>Forme compliqu&eacute;e</strong></td><td><ul><li><strong>Hospitalisation en urgence</strong></li><li><strong><strong>Drainage chirurgical ou radioguid&eacute; des abc&egrave;s &gt; 3-4 cm</strong></strong></li><li><strong><strong>Antibioth&eacute;rapie :</strong></strong><ul><li data-w-id="07e37eb2-173d-6d69-0182-f180c24944c2" data-wf-id="[&quot;07e37eb2-173d-6d69-0182-f180c24944c2&quot;]" data-automation-id="dyn-item-diagnostics-input">Ceftriaxone 1-2 g/j (2 g si signes de gravt&eacute; ou poids &gt; 80kg) IV, jusqu'&agrave; am&eacute;lioration, ET</li><li data-w-id="937d1e80-f46a-8495-13a8-cee8ddb954f6" data-wf-id="[&quot;937d1e80-f46a-8495-13a8-cee8ddb954f6&quot;]" data-automation-id="dyn-item-diagnostics-input">Doxycycline 14 jours, ET</li><li data-w-id="a5a86034-93af-b82f-bd6f-49b3380f64d9" data-wf-id="[&quot;a5a86034-93af-b82f-bd6f-49b3380f64d9&quot;]" data-automation-id="dyn-item-diagnostics-input">M&eacute;tronidazole 14 jours</li></ul></li><li data-w-id="a3ba6a59-0a47-17f2-5af8-9cf59cf35036" data-wf-id="[&quot;a3ba6a59-0a47-17f2-5af8-9cf59cf35036&quot;]" data-automation-id="dyn-item-diagnostics-input">Retrait d'un DIU.</li></ul></td></tr></tbody></table>‍

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<table border="1" cellpadding="5"><caption>Tableau 1 - Leucorrh&eacute;es</caption><tbody><tr><th colspan="2">Leucorrh&eacute;es physiologiques</th></tr><tr><td colspan="2"><ul><li data-w-id="995f8c47-2faa-ccf5-0e7f-be61d7fe7537" data-wf-id="[&quot;995f8c47-2faa-ccf5-0e7f-be61d7fe7537&quot;]" data-automation-id="dyn-item-diagnostics-input">Laiteuses ou translucides, peu abondantes, augmentant en p&eacute;riode pr&eacute;menstruelle,</li><li data-w-id="5e54d327-0b41-b666-419e-bcad6e2854b4" data-wf-id="[&quot;5e54d327-0b41-b666-419e-bcad6e2854b4&quot;]" data-automation-id="dyn-item-diagnostics-input">Inodores, non irritantes,</li><li data-w-id="f017be03-afb6-4731-cf92-070752c591c5" data-wf-id="[&quot;f017be03-afb6-4731-cf92-070752c591c5&quot;]" data-automation-id="dyn-item-diagnostics-input">Ne contiennent pas de polynucl&eacute;aire,</li><li data-w-id="c2980f4d-e5a1-8d1c-5a7e-fb4ed0e6191b" data-wf-id="[&quot;c2980f4d-e5a1-8d1c-5a7e-fb4ed0e6191b&quot;]" data-automation-id="dyn-item-diagnostics-input">Flore dominante = bacille de D&ouml;derlein.</li></ul></td></tr><tr><th colspan="2">Leucorrh&eacute;es pathologiques</th></tr><tr><td style="background-color: #bef2d3; text-align: center;" colspan="2"><strong>Diagnostic</strong></td></tr><tr><td style="text-align: center;"><strong>Clinique</strong></td><td><p>Signes &eacute;vocateurs d'une infection g&eacute;nitale :</p><ul><li data-w-id="a6cac40d-6336-44b2-5cb8-9fbee741b2c7" data-wf-id="[&quot;a6cac40d-6336-44b2-5cb8-9fbee741b2c7&quot;]" data-automation-id="dyn-item-diagnostics-input">Leucorrh&eacute;es malodorantes,</li><li data-w-id="88b0edd3-50d6-9cd1-834c-ea3909f128be" data-wf-id="[&quot;88b0edd3-50d6-9cd1-834c-ea3909f128be&quot;]" data-automation-id="dyn-item-diagnostics-input">Prurit ou br&ucirc;lures,</li><li data-w-id="c92c5a05-eec3-d1e0-fac2-4b69c272ed1f" data-wf-id="[&quot;c92c5a05-eec3-d1e0-fac2-4b69c272ed1f&quot;]" data-automation-id="dyn-item-diagnostics-input">M&eacute;trorragies, douleurs pelviennes ou signes g&eacute;n&eacute;raux associ&eacute;es (orientent vers une cervicite ou une infection g&eacute;nitale haute),</li><li data-w-id="0704fd2d-e4ef-9c0b-2b47-4ac572db9677" data-wf-id="[&quot;0704fd2d-e4ef-9c0b-2b47-4ac572db9677&quot;]" data-automation-id="dyn-item-diagnostics-input">Signes fonctionnels urinaires associ&eacute;s,</li><li data-w-id="b7a114ad-9316-6770-8ba1-6057686baa35" data-wf-id="[&quot;b7a114ad-9316-6770-8ba1-6057686baa35&quot;]" data-automation-id="dyn-item-diagnostics-input">Inflammation vulvaire, v&eacute;sicules, ulc&eacute;rations.</li></ul></td></tr><tr><td style="text-align: center;"><strong>Paraclinique</strong><br /><strong> (hors infection g&eacute;nitale haute)</strong></td><td><p>Pr&eacute;l&egrave;vement vaginal (<a href="https://www.ordotype.fr/ordonnances-types/prelevements-microbiologiques-leucorrhees" target="_blank" rel="noopener">ordonnance</a>) :</p><ul><li data-w-id="1234bc9b-cf6f-122d-bd3f-89adf389b540" data-wf-id="[&quot;1234bc9b-cf6f-122d-bd3f-89adf389b540&quot;]" data-automation-id="dyn-item-diagnostics-input">Examen direct &agrave; l'&eacute;tat frais,</li><li data-w-id="8c904b5b-19da-f993-64cc-38634d747dfe" data-wf-id="[&quot;8c904b5b-19da-f993-64cc-38634d747dfe&quot;]" data-automation-id="dyn-item-diagnostics-input">Analyse mycologique,</li><li data-w-id="62d71766-0721-9d0d-9ccb-bd65bf3d497a" data-wf-id="[&quot;62d71766-0721-9d0d-9ccb-bd65bf3d497a&quot;]" data-automation-id="dyn-item-diagnostics-input">Analyse bact&eacute;riologique,</li><li data-w-id="265bc0fd-d721-79a3-0cae-19cf07bd7d20" data-wf-id="[&quot;265bc0fd-d721-79a3-0cae-19cf07bd7d20&quot;]" data-automation-id="dyn-item-diagnostics-input">PCR Chlamydiae, gonocoque, mycoplasmes.</li></ul></td></tr><tr><td style="background-color: #def3e5; text-align: center;" colspan="2"><strong>Principales &eacute;tiologies</strong></td></tr><tr><td style="text-align: center;"><p data-w-id="4b6ddf45-4b67-5a9a-3f87-44ab1bee556e" data-wf-id="[&quot;4b6ddf45-4b67-5a9a-3f87-44ab1bee556e&quot;]" data-automation-id="dyn-item-diagnostics-input"><strong>Trichomonas</strong></p></td><td><ul><li data-w-id="016c4151-8b53-d2c1-1d7b-d12261ef896c" data-wf-id="[&quot;016c4151-8b53-d2c1-1d7b-d12261ef896c&quot;]" data-automation-id="dyn-item-diagnostics-input">Leucorrh&eacute;es verd&acirc;tres et naus&eacute;abondes,</li><li data-w-id="b8dfce5d-4f91-4330-434f-448ef0c930d9" data-wf-id="[&quot;b8dfce5d-4f91-4330-434f-448ef0c930d9&quot;]" data-automation-id="dyn-item-diagnostics-input">Traitement par m&eacute;tronidazole (<a href="https://www.ordotype.fr/ordonnances-types/traitement-vaginose-bacterienne" target="_blank" rel="noopener">ordonnance</a>),</li><li data-w-id="76be031d-1d0e-8b3a-cd7a-f32413a48bc8" data-wf-id="[&quot;76be031d-1d0e-8b3a-cd7a-f32413a48bc8&quot;]" data-automation-id="dyn-item-diagnostics-input">Traiter les partenaires sexuels,</li><li data-w-id="89bf73bd-31c4-5e8f-c3b1-1150e17cf508" data-wf-id="[&quot;89bf73bd-31c4-5e8f-c3b1-1150e17cf508&quot;]" data-automation-id="dyn-item-diagnostics-input">Bilan d'IST (<a href="https://www.ordotype.fr/ordonnances-types/ist-prise-de-risque-asymptomatique-femme-dont-rapport-oraux-et-anaux" target="_blank" rel="noopener">ordonnance</a>).</li></ul></td></tr><tr><td style="text-align: center;"><p><strong>Mycose</strong></p></td><td><ul><li data-w-id="b583c7d7-deaa-718e-af5a-484c1b87e20d" data-wf-id="[&quot;b583c7d7-deaa-718e-af5a-484c1b87e20d&quot;]" data-automation-id="dyn-item-diagnostics-input">Prurit +++,</li><li data-w-id="1090e50a-ea74-3083-e03c-b3ef66adb92b" data-wf-id="[&quot;1090e50a-ea74-3083-e03c-b3ef66adb92b&quot;]" data-automation-id="dyn-item-diagnostics-input">Leucorrh&eacute;es blanches, grumeleuses,</li><li data-w-id="87a71afe-d97a-7414-b496-356ae4d99764" data-wf-id="[&quot;87a71afe-d97a-7414-b496-356ae4d99764&quot;]" data-automation-id="dyn-item-diagnostics-input">Traitement par antifongique topique (<a href="https://www.ordotype.fr/ordonnances-types/candidose-geniale-vulvovaginite" target="_blank" rel="noopener">ordonnance</a>),</li><li data-w-id="bc2cc31a-dd25-1259-4aef-fd216f2c14d1" data-wf-id="[&quot;bc2cc31a-dd25-1259-4aef-fd216f2c14d1&quot;]" data-automation-id="dyn-item-diagnostics-input">Pas besoin de traiter le partenaire en l'absence de sympt&ocirc;mes,</li><li data-w-id="6cd7d9a2-708a-186a-611f-23d20cfd4576" data-wf-id="[&quot;6cd7d9a2-708a-186a-611f-23d20cfd4576&quot;]" data-automation-id="dyn-item-diagnostics-input">En cas de r&eacute;cidive fr&eacute;quentes :<ul><li data-w-id="048421f7-8e08-96b9-345a-9166344fc706" data-wf-id="[&quot;048421f7-8e08-96b9-345a-9166344fc706&quot;]" data-automation-id="dyn-item-diagnostics-input">Rechercher un facteur favorisant,</li><li data-w-id="a6633d1c-dbf3-2480-ad82-0044ece97fe5" data-wf-id="[&quot;a6633d1c-dbf3-2480-ad82-0044ece97fe5&quot;]" data-automation-id="dyn-item-diagnostics-input">Envisager un traitement au long cours.&nbsp;</li></ul></li></ul></td></tr><tr><td style="text-align: center;"><p><strong>Vaginose bact&eacute;rienne</strong></p></td><td><ul><li data-w-id="38cc841c-a098-8eb3-2c51-6788ff7aa3e1" data-wf-id="[&quot;38cc841c-a098-8eb3-2c51-6788ff7aa3e1&quot;]" data-automation-id="dyn-item-diagnostics-input">Pertes grises peu abondantes et malodorantes,</li><li data-w-id="da5224c0-5b0e-46d8-edc1-e6db440b2c94" data-wf-id="[&quot;da5224c0-5b0e-46d8-edc1-e6db440b2c94&quot;]" data-automation-id="dyn-item-diagnostics-input">Score de Nugent &eacute;lev&eacute; sur le pr&eacute;l&egrave;vement vaginal,</li><li data-w-id="a64c9fdd-f9b6-7578-8d6b-f61f4eb67d31" data-wf-id="[&quot;a64c9fdd-f9b6-7578-8d6b-f61f4eb67d31&quot;]" data-automation-id="dyn-item-diagnostics-input">Traitement par m&eacute;tronidazole (<a href="/ordonnances-types/traitement-vaginose-bacterienne" target="_blank" rel="noopener">ordonnance</a>),</li><li data-w-id="abf769a1-9ae7-439b-26ff-c8dfc3589fd0" data-wf-id="[&quot;abf769a1-9ae7-439b-26ff-c8dfc3589fd0&quot;]" data-automation-id="dyn-item-diagnostics-input">Traitement du partenaire inutile.</li></ul></td></tr><tr><td><p style="text-align: center;"><strong>Autres</strong></p></td><td><ul><li data-w-id="f9e9d865-e601-ca5b-ed91-870ebc55161a" data-wf-id="[&quot;f9e9d865-e601-ca5b-ed91-870ebc55161a&quot;]" data-automation-id="dyn-item-diagnostics-input"><strong>IST</strong> (<a href="https://www.ordotype.fr/pathologies/infections-sexuellement-transmissibles-ist-mst" target="_blank" rel="noopener">voir la fiche</a>),</li><li data-w-id="3fb4ad5b-5c5a-42ca-e6b9-907161dc21f7" data-wf-id="[&quot;3fb4ad5b-5c5a-42ca-e6b9-907161dc21f7&quot;]" data-automation-id="dyn-item-diagnostics-input">Corps &eacute;tranger intravaginal,</li><li data-w-id="9d8f44f9-d793-ba3b-4199-71b092660e3b" data-wf-id="[&quot;9d8f44f9-d793-ba3b-4199-71b092660e3b&quot;]" data-automation-id="dyn-item-diagnostics-input">N&eacute;oplasie,</li><li data-w-id="35954b04-7e0c-6dfd-f85b-e14e9561e0a6" data-wf-id="[&quot;35954b04-7e0c-6dfd-f85b-e14e9561e0a6&quot;]" data-automation-id="dyn-item-diagnostics-input">Atrophie par carence hormonale (femme m&eacute;nopaus&eacute;e),</li><li data-w-id="35954b04-7e0c-6dfd-f85b-e14e9561e0a6" data-wf-id="[&quot;35954b04-7e0c-6dfd-f85b-e14e9561e0a6&quot;]" data-automation-id="dyn-item-diagnostics-input">Jeune fille :<ul><li data-w-id="35954b04-7e0c-6dfd-f85b-e14e9561e0a6" data-wf-id="[&quot;35954b04-7e0c-6dfd-f85b-e14e9561e0a6&quot;]" data-automation-id="dyn-item-diagnostics-input">Vulvovaginite &agrave; germes banals (<em>S. pyogenes</em>),</li><li data-w-id="35954b04-7e0c-6dfd-f85b-e14e9561e0a6" data-wf-id="[&quot;35954b04-7e0c-6dfd-f85b-e14e9561e0a6&quot;]" data-automation-id="dyn-item-diagnostics-input">Oxyurose,</li><li data-w-id="35954b04-7e0c-6dfd-f85b-e14e9561e0a6" data-wf-id="[&quot;35954b04-7e0c-6dfd-f85b-e14e9561e0a6&quot;]" data-automation-id="dyn-item-diagnostics-input">Corps &eacute;tranger intravaginal</li></ul></li></ul></td></tr></tbody></table><p>&nbsp;</p><table border="1" cellpadding="5"><caption>Tableau 2 - Infection g&eacute;nitales hautes (hors post-partum)</caption><tbody><tr><th colspan="2"><strong data-w-id="238f8bbb-f0a4-3b9b-1497-50ad7b1a4c8a" data-wf-id="[&quot;238f8bbb-f0a4-3b9b-1497-50ad7b1a4c8a&quot;]" data-automation-id="dyn-item-diagnostics-input">Infections g&eacute;nitales hautes</strong></th></tr><tr><td style="background-color: #bef2d3; text-align: center;" colspan="2"><strong>G&eacute;n&eacute;ralit&eacute;s</strong></td></tr><tr><td><p style="text-align: center;"><strong>Principaux germes</strong></p></td><td><ul><li data-w-id="0e1c9bdc-bd7e-1d30-c83d-3b5073ab21fb" data-wf-id="[&quot;0e1c9bdc-bd7e-1d30-c83d-3b5073ab21fb&quot;]" data-automation-id="dyn-item-diagnostics-input">Germes des IST,</li><li data-w-id="d0fe7efa-2182-aab1-a7e5-ade6455b0e0d" data-wf-id="[&quot;d0fe7efa-2182-aab1-a7e5-ade6455b0e0d&quot;]" data-automation-id="dyn-item-diagnostics-input">Germes opportunistes issus de la flore vaginale,</li><li data-w-id="14f24e6e-b32b-ea7b-eaca-712044ed3872" data-wf-id="[&quot;14f24e6e-b32b-ea7b-eaca-712044ed3872&quot;]" data-automation-id="dyn-item-diagnostics-input">Exceptionnellement : tuberculose ou bilharziose.</li></ul></td></tr><tr><td style="background-color: #bef2d3; text-align: center;" colspan="2"><strong>Diagnostic positif</strong></td></tr><tr><td style="text-align: center;"><p><strong>Clinique</strong></p></td><td><ul><li data-w-id="80079081-40a8-559b-3944-d528949fc393" data-wf-id="[&quot;80079081-40a8-559b-3944-d528949fc393&quot;]" data-automation-id="dyn-item-diagnostics-input">Douleurs pelviennes / dyspareunies,</li><li data-w-id="741ca1e2-0460-a43a-cbaa-dcb341b2bd7d" data-wf-id="[&quot;741ca1e2-0460-a43a-cbaa-dcb341b2bd7d&quot;]" data-automation-id="dyn-item-diagnostics-input">Leucorrh&eacute;es pathologiques,</li><li data-w-id="9c51f569-a6b5-903d-e236-82f1598771a5" data-wf-id="[&quot;9c51f569-a6b5-903d-e236-82f1598771a5&quot;]" data-automation-id="dyn-item-diagnostics-input">Douleurs &agrave; la mobilisation ut&eacute;rine au toucher vaginal,</li><li data-w-id="0ce031d1-5abe-68b2-b56a-7f831e58c83e" data-wf-id="[&quot;0ce031d1-5abe-68b2-b56a-7f831e58c83e&quot;]" data-automation-id="dyn-item-diagnostics-input">+/- M&eacute;trorragies,</li><li data-w-id="295597d2-fcd7-6375-ead5-cd6a3ad8b41c" data-wf-id="[&quot;295597d2-fcd7-6375-ead5-cd6a3ad8b41c&quot;]" data-automation-id="dyn-item-diagnostics-input">+/- Douleurs dans les culs-de-sac vaginaux,</li><li data-w-id="46e0ba4b-05ba-5850-7825-1470b52d6ca0" data-wf-id="[&quot;46e0ba4b-05ba-5850-7825-1470b52d6ca0&quot;]" data-automation-id="dyn-item-diagnostics-input">+&nbsp;/- Signes fonctionnels urinaires,</li><li data-w-id="921b72e4-cb2e-67be-f74e-3d8755ec2dd6" data-wf-id="[&quot;921b72e4-cb2e-67be-f74e-3d8755ec2dd6&quot;]" data-automation-id="dyn-item-diagnostics-input">Absence de signes g&eacute;n&eacute;raux ou d'irritation p&eacute;riton&eacute;ales, dans les formes non compliqu&eacute;es,</li><li data-w-id="eb601134-f092-3c3e-59ca-7509c6ec74c3" data-wf-id="[&quot;eb601134-f092-3c3e-59ca-7509c6ec74c3&quot;]" data-automation-id="dyn-item-diagnostics-input">Absence de d&eacute;fense ou de contracture (m&ecirc;me si des douleurs abdominales peuvent exister, doivent faire &eacute;voquer une complication).</li></ul></td></tr><tr><td style="text-align: center;"><p><strong>Paraclinique</strong></p></td><td><ul><li data-w-id="de86e4ed-fab0-d5de-4f58-96d6abaf55da" data-wf-id="[&quot;de86e4ed-fab0-d5de-4f58-96d6abaf55da&quot;]" data-automation-id="dyn-item-diagnostics-input">Biologiques (<a href="https://www.ordotype.fr/ordonnances-types/prelevements-endocervical-infections-genitales-hautes" target="_blank" rel="noopener">ordonnance</a>) :<ul><li data-w-id="7fa2af8a-89db-86a7-f913-ae3a3584a97a" data-wf-id="[&quot;7fa2af8a-89db-86a7-f913-ae3a3584a97a&quot;]" data-automation-id="dyn-item-diagnostics-input">NFS, CRP : normaux en cas de forme non compliqu&eacute;e,</li><li data-w-id="e9431900-b93d-cb6c-aa3d-67f242fa50ed" data-wf-id="[&quot;e9431900-b93d-cb6c-aa3d-67f242fa50ed&quot;]" data-automation-id="dyn-item-diagnostics-input">Beta-HCG,</li><li data-w-id="4beac824-face-4491-dc0e-bbdfa85b090a" data-wf-id="[&quot;4beac824-face-4491-dc0e-bbdfa85b090a&quot;]" data-automation-id="dyn-item-diagnostics-input">ECBU,</li><li data-w-id="f5d70ba3-2b69-45fb-cdb9-60c0e20780ed" data-wf-id="[&quot;f5d70ba3-2b69-45fb-cdb9-60c0e20780ed&quot;]" data-automation-id="dyn-item-diagnostics-input">PCR Chlamydiae, gonocoque, mycoplasmes,</li><li data-w-id="30a44a84-cb48-a70b-655d-89054a0c49b6" data-wf-id="[&quot;30a44a84-cb48-a70b-655d-89054a0c49b6&quot;]" data-automation-id="dyn-item-diagnostics-input">Pr&eacute;l&egrave;vement endocervical en cas de suspicion d'infection g&eacute;nitale haute (auto-pr&eacute;l&egrave;vement vaginal en 2<sup>&egrave;me</sup> choix, si pr&eacute;l&egrave;vement guid&eacute; par sp&eacute;culum impossible),</li><li data-w-id="f7cae078-9277-ad60-ab54-558041ea7717" data-wf-id="[&quot;f7cae078-9277-ad60-ab54-558041ea7717&quot;]" data-automation-id="dyn-item-diagnostics-input">Mise en culture d'un &eacute;ventuel st&eacute;rilet.</li></ul></li><li data-w-id="a55639d7-1d3a-e063-c11e-691249cb8030" data-wf-id="[&quot;a55639d7-1d3a-e063-c11e-691249cb8030&quot;]" data-automation-id="dyn-item-diagnostics-input">Echographie pelvienne (<a href="https://www.ordotype.fr/ordonnances-types/echographie-infection-genitale-haute" target="_blank" rel="noopener">ordonnance</a>) :<ul><li data-w-id="a55639d7-1d3a-e063-c11e-691249cb8030" data-wf-id="[&quot;a55639d7-1d3a-e063-c11e-691249cb8030&quot;]" data-automation-id="dyn-item-diagnostics-input">recherche de complications ou</li><li data-w-id="a55639d7-1d3a-e063-c11e-691249cb8030" data-wf-id="[&quot;a55639d7-1d3a-e063-c11e-691249cb8030&quot;]" data-automation-id="dyn-item-diagnostics-input">de diagnostic diff&eacute;rentiel.&nbsp;</li></ul></li><li data-w-id="76d8b577-fd7b-6b34-7ac1-8997931ec7f0" data-wf-id="[&quot;76d8b577-fd7b-6b34-7ac1-8997931ec7f0&quot;]" data-automation-id="dyn-item-diagnostics-input">En cas de doute avec un diagnostic diff&eacute;rentiel : TDM, IRM voir coelioscopie.</li></ul></td></tr><tr><td style="text-align: center;"><p><strong>Complications</strong></p></td><td><ul><li data-w-id="3f45abd5-0707-2a86-ddd7-ad2bccb07e39" data-wf-id="[&quot;3f45abd5-0707-2a86-ddd7-ad2bccb07e39&quot;]" data-automation-id="dyn-item-diagnostics-input">Aigu&euml;s <strong>(Hospitalisation pour pr&eacute;l&egrave;vements chirurgicaux ou &eacute;choguid&eacute;s)</strong> :<ul><li data-w-id="3f8ef4b9-6a53-0ab3-49e7-7a8de49b723f" data-wf-id="[&quot;3f8ef4b9-6a53-0ab3-49e7-7a8de49b723f&quot;]" data-automation-id="dyn-item-diagnostics-input">Pelvi-p&eacute;ritonites,</li><li data-w-id="4c56446b-1d21-fb6b-a30f-7946c9a8de75" data-wf-id="[&quot;4c56446b-1d21-fb6b-a30f-7946c9a8de75&quot;]" data-automation-id="dyn-item-diagnostics-input">Abc&egrave;s pelvien.</li></ul></li><li data-w-id="5c70d4b2-8bd2-e926-5e71-b60897dba1df" data-wf-id="[&quot;5c70d4b2-8bd2-e926-5e71-b60897dba1df&quot;]" data-automation-id="dyn-item-diagnostics-input">&Agrave; long terme :<ul><li data-w-id="0572913d-5d3f-ef9c-8fb0-061a015f486f" data-wf-id="[&quot;0572913d-5d3f-ef9c-8fb0-061a015f486f&quot;]" data-automation-id="dyn-item-diagnostics-input">Infertilit&eacute;,</li><li data-w-id="720d12f4-8350-6b4e-8616-ca4aba40718f" data-wf-id="[&quot;720d12f4-8350-6b4e-8616-ca4aba40718f&quot;]" data-automation-id="dyn-item-diagnostics-input">GEU,</li><li data-w-id="5b82d2e3-196a-43ae-0040-a58fe4155174" data-wf-id="[&quot;5b82d2e3-196a-43ae-0040-a58fe4155174&quot;]" data-automation-id="dyn-item-diagnostics-input">Douleurs pelviennes chroniques.</li></ul></li></ul></td></tr><tr><td style="background-color: #bef2d3; text-align: center;" colspan="2"><strong>Traitement</strong></td></tr><tr><td style="text-align: center;"><p><strong>G&eacute;n&eacute;ralit&eacute;s</strong></p></td><td><p><strong>D&eacute;buter sans attendre les r&eacute;sultats des examens.</strong></p><ul><li data-w-id="4329d0c2-c115-1e2d-049e-18a3163b6e08" data-wf-id="[&quot;4329d0c2-c115-1e2d-049e-18a3163b6e08&quot;]" data-automation-id="dyn-item-diagnostics-input">Seules les formes non compliqu&eacute;es peuvent &ecirc;tre prises en charge en ambulatoire, les autres doivent &ecirc;tre hospitalis&eacute;es en urgence.&nbsp;</li><li data-w-id="768e4093-d65c-af54-ab02-fa77165646ca" data-wf-id="[&quot;768e4093-d65c-af54-ab02-fa77165646ca&quot;]" data-automation-id="dyn-item-diagnostics-input">Traitement de la patiente et du partenaire et protection des rapports en cas d'IST,</li><li data-w-id="0e2f2397-adba-5110-3c33-fd8a0e306f54" data-wf-id="[&quot;0e2f2397-adba-5110-3c33-fd8a0e306f54&quot;]" data-automation-id="dyn-item-diagnostics-input">Retrait d'un DIU non syst&eacute;matique mais &agrave; discuter (avis sp&eacute;cialis&eacute;),</li><li data-w-id="4d599ac2-1e27-d07d-eed9-e007530d0c6f" data-wf-id="[&quot;4d599ac2-1e27-d07d-eed9-e007530d0c6f&quot;]" data-automation-id="dyn-item-diagnostics-input">Traitement symptomatique,</li><li data-w-id="4d599ac2-1e27-d07d-eed9-e007530d0c6f" data-wf-id="[&quot;4d599ac2-1e27-d07d-eed9-e007530d0c6f&quot;]" data-automation-id="dyn-item-diagnostics-input">R&eacute;&eacute;valuation syst&eacute;matique &agrave; 3-6 mois pour v&eacute;rifier l'absence de r&eacute;cidive</li></ul></td></tr><tr><td style="text-align: center;"><strong>Forme non compliqu&eacute;e</strong></td><td><ul><li>Traitement ambulatoire possible</li><li>Hospitalisation si forme non compliqu&eacute;e interm&eacute;diaire :<ul><li>Doute diagnostique,</li><li>Sympt&ocirc;mes tr&egrave;s intenses,</li><li>Difficult&eacute; de prise des antibiotiques oraux,</li><li>&Eacute;chec d'un traitement ant&eacute;rieur,</li><li>D&eacute;tresse psychosociale.</li></ul></li><li>Antibioth&eacute;rapie (<a href="https://www.ordotype.fr/ordonnances-types/infection-genitale-haute" target="_blank" rel="noopener">ordonnance</a>) :<ul><li data-w-id="07e37eb2-173d-6d69-0182-f180c24944c2" data-wf-id="[&quot;07e37eb2-173d-6d69-0182-f180c24944c2&quot;]" data-automation-id="dyn-item-diagnostics-input">Ceftriaxone dose unique IM (<a href="https://www.ordotype.fr/ordonnances-types/ide-ceftriaxone-infection-genitale-haute" target="_blank" rel="noopener">ordonnance injection par IDE</a>), ET</li><li data-w-id="937d1e80-f46a-8495-13a8-cee8ddb954f6" data-wf-id="[&quot;937d1e80-f46a-8495-13a8-cee8ddb954f6&quot;]" data-automation-id="dyn-item-diagnostics-input">Doxycycline 10 jours, ET</li><li data-w-id="a5a86034-93af-b82f-bd6f-49b3380f64d9" data-wf-id="[&quot;a5a86034-93af-b82f-bd6f-49b3380f64d9&quot;]" data-automation-id="dyn-item-diagnostics-input">M&eacute;tronidazole 10 jours</li></ul></li><li data-w-id="a3ba6a59-0a47-17f2-5af8-9cf59cf35036" data-wf-id="[&quot;a3ba6a59-0a47-17f2-5af8-9cf59cf35036&quot;]" data-automation-id="dyn-item-diagnostics-input">Revoir obligatoirement entre 3 et 5 jours pour juger de l'&eacute;volution et v&eacute;rifier l'observance,</li><li>Retrait d'un DIU non syst&eacute;matique mais &agrave; discuter (avis sp&eacute;cialis&eacute;).</li></ul></td></tr><tr><td style="text-align: center;"><strong>Forme compliqu&eacute;e</strong></td><td><ul><li><strong>Hospitalisation en urgence</strong></li><li><strong><strong>Drainage chirurgical ou radioguid&eacute; des abc&egrave;s &gt; 3-4 cm</strong></strong></li><li><strong><strong>Antibioth&eacute;rapie :</strong></strong><ul><li data-w-id="07e37eb2-173d-6d69-0182-f180c24944c2" data-wf-id="[&quot;07e37eb2-173d-6d69-0182-f180c24944c2&quot;]" data-automation-id="dyn-item-diagnostics-input">Ceftriaxone 1-2 g/j (2 g si signes de gravt&eacute; ou poids &gt; 80kg) IV, jusqu'&agrave; am&eacute;lioration, ET</li><li data-w-id="937d1e80-f46a-8495-13a8-cee8ddb954f6" data-wf-id="[&quot;937d1e80-f46a-8495-13a8-cee8ddb954f6&quot;]" data-automation-id="dyn-item-diagnostics-input">Doxycycline 14 jours, ET</li><li data-w-id="a5a86034-93af-b82f-bd6f-49b3380f64d9" data-wf-id="[&quot;a5a86034-93af-b82f-bd6f-49b3380f64d9&quot;]" data-automation-id="dyn-item-diagnostics-input">M&eacute;tronidazole 14 jours</li></ul></li><li data-w-id="a3ba6a59-0a47-17f2-5af8-9cf59cf35036" data-wf-id="[&quot;a3ba6a59-0a47-17f2-5af8-9cf59cf35036&quot;]" data-automation-id="dyn-item-diagnostics-input">Retrait d'un DIU.</li></ul></td></tr></tbody></table>‍

<table border="1" cellpadding="5"><caption>Tableau 1 - Leucorrh&eacute;es</caption><tbody><tr><th colspan="2">Leucorrh&eacute;es physiologiques</th></tr><tr><td colspan="2"><ul><li data-w-id="995f8c47-2faa-ccf5-0e7f-be61d7fe7537" data-wf-id="[&quot;995f8c47-2faa-ccf5-0e7f-be61d7fe7537&quot;]" data-automation-id="dyn-item-diagnostics-input">Laiteuses ou translucides, peu abondantes, augmentant en p&eacute;riode pr&eacute;menstruelle,</li><li data-w-id="5e54d327-0b41-b666-419e-bcad6e2854b4" data-wf-id="[&quot;5e54d327-0b41-b666-419e-bcad6e2854b4&quot;]" data-automation-id="dyn-item-diagnostics-input">Inodores, non irritantes,</li><li data-w-id="f017be03-afb6-4731-cf92-070752c591c5" data-wf-id="[&quot;f017be03-afb6-4731-cf92-070752c591c5&quot;]" data-automation-id="dyn-item-diagnostics-input">Ne contiennent pas de polynucl&eacute;aire,</li><li data-w-id="c2980f4d-e5a1-8d1c-5a7e-fb4ed0e6191b" data-wf-id="[&quot;c2980f4d-e5a1-8d1c-5a7e-fb4ed0e6191b&quot;]" data-automation-id="dyn-item-diagnostics-input">Flore dominante = bacille de D&ouml;derlein.</li></ul></td></tr><tr><th colspan="2">Leucorrh&eacute;es pathologiques</th></tr><tr><td style="background-color: #bef2d3; text-align: center;" colspan="2"><strong>Diagnostic</strong></td></tr><tr><td style="text-align: center;"><strong>Clinique</strong></td><td><p>Signes &eacute;vocateurs d'une infection g&eacute;nitale :</p><ul><li data-w-id="a6cac40d-6336-44b2-5cb8-9fbee741b2c7" data-wf-id="[&quot;a6cac40d-6336-44b2-5cb8-9fbee741b2c7&quot;]" data-automation-id="dyn-item-diagnostics-input">Leucorrh&eacute;es malodorantes,</li><li data-w-id="88b0edd3-50d6-9cd1-834c-ea3909f128be" data-wf-id="[&quot;88b0edd3-50d6-9cd1-834c-ea3909f128be&quot;]" data-automation-id="dyn-item-diagnostics-input">Prurit ou br&ucirc;lures,</li><li data-w-id="c92c5a05-eec3-d1e0-fac2-4b69c272ed1f" data-wf-id="[&quot;c92c5a05-eec3-d1e0-fac2-4b69c272ed1f&quot;]" data-automation-id="dyn-item-diagnostics-input">M&eacute;trorragies, douleurs pelviennes ou signes g&eacute;n&eacute;raux associ&eacute;es (orientent vers une cervicite ou une infection g&eacute;nitale haute),</li><li data-w-id="0704fd2d-e4ef-9c0b-2b47-4ac572db9677" data-wf-id="[&quot;0704fd2d-e4ef-9c0b-2b47-4ac572db9677&quot;]" data-automation-id="dyn-item-diagnostics-input">Signes fonctionnels urinaires associ&eacute;s,</li><li data-w-id="b7a114ad-9316-6770-8ba1-6057686baa35" data-wf-id="[&quot;b7a114ad-9316-6770-8ba1-6057686baa35&quot;]" data-automation-id="dyn-item-diagnostics-input">Inflammation vulvaire, v&eacute;sicules, ulc&eacute;rations.</li></ul></td></tr><tr><td style="text-align: center;"><strong>Paraclinique</strong><br /><strong> (hors infection g&eacute;nitale haute)</strong></td><td><p>Pr&eacute;l&egrave;vement vaginal (<a href="https://www.ordotype.fr/ordonnances-types/prelevements-microbiologiques-leucorrhees" target="_blank" rel="noopener">ordonnance</a>) :</p><ul><li data-w-id="1234bc9b-cf6f-122d-bd3f-89adf389b540" data-wf-id="[&quot;1234bc9b-cf6f-122d-bd3f-89adf389b540&quot;]" data-automation-id="dyn-item-diagnostics-input">Examen direct &agrave; l'&eacute;tat frais,</li><li data-w-id="8c904b5b-19da-f993-64cc-38634d747dfe" data-wf-id="[&quot;8c904b5b-19da-f993-64cc-38634d747dfe&quot;]" data-automation-id="dyn-item-diagnostics-input">Analyse mycologique,</li><li data-w-id="62d71766-0721-9d0d-9ccb-bd65bf3d497a" data-wf-id="[&quot;62d71766-0721-9d0d-9ccb-bd65bf3d497a&quot;]" data-automation-id="dyn-item-diagnostics-input">Analyse bact&eacute;riologique,</li><li data-w-id="265bc0fd-d721-79a3-0cae-19cf07bd7d20" data-wf-id="[&quot;265bc0fd-d721-79a3-0cae-19cf07bd7d20&quot;]" data-automation-id="dyn-item-diagnostics-input">PCR Chlamydiae, gonocoque, mycoplasmes.</li></ul></td></tr><tr><td style="background-color: #def3e5; text-align: center;" colspan="2"><strong>Principales &eacute;tiologies</strong></td></tr><tr><td style="text-align: center;"><p data-w-id="4b6ddf45-4b67-5a9a-3f87-44ab1bee556e" data-wf-id="[&quot;4b6ddf45-4b67-5a9a-3f87-44ab1bee556e&quot;]" data-automation-id="dyn-item-diagnostics-input"><strong>Trichomonas</strong></p></td><td><ul><li data-w-id="016c4151-8b53-d2c1-1d7b-d12261ef896c" data-wf-id="[&quot;016c4151-8b53-d2c1-1d7b-d12261ef896c&quot;]" data-automation-id="dyn-item-diagnostics-input">Leucorrh&eacute;es verd&acirc;tres et naus&eacute;abondes,</li><li data-w-id="b8dfce5d-4f91-4330-434f-448ef0c930d9" data-wf-id="[&quot;b8dfce5d-4f91-4330-434f-448ef0c930d9&quot;]" data-automation-id="dyn-item-diagnostics-input">Traitement par m&eacute;tronidazole (<a href="https://www.ordotype.fr/ordonnances-types/traitement-vaginose-bacterienne" target="_blank" rel="noopener">ordonnance</a>),</li><li data-w-id="76be031d-1d0e-8b3a-cd7a-f32413a48bc8" data-wf-id="[&quot;76be031d-1d0e-8b3a-cd7a-f32413a48bc8&quot;]" data-automation-id="dyn-item-diagnostics-input">Traiter les partenaires sexuels,</li><li data-w-id="89bf73bd-31c4-5e8f-c3b1-1150e17cf508" data-wf-id="[&quot;89bf73bd-31c4-5e8f-c3b1-1150e17cf508&quot;]" data-automation-id="dyn-item-diagnostics-input">Bilan d'IST (<a href="https://www.ordotype.fr/ordonnances-types/ist-prise-de-risque-asymptomatique-femme-dont-rapport-oraux-et-anaux" target="_blank" rel="noopener">ordonnance</a>).</li></ul></td></tr><tr><td style="text-align: center;"><p><strong>Mycose</strong></p></td><td><ul><li data-w-id="b583c7d7-deaa-718e-af5a-484c1b87e20d" data-wf-id="[&quot;b583c7d7-deaa-718e-af5a-484c1b87e20d&quot;]" data-automation-id="dyn-item-diagnostics-input">Prurit +++,</li><li data-w-id="1090e50a-ea74-3083-e03c-b3ef66adb92b" data-wf-id="[&quot;1090e50a-ea74-3083-e03c-b3ef66adb92b&quot;]" data-automation-id="dyn-item-diagnostics-input">Leucorrh&eacute;es blanches, grumeleuses,</li><li data-w-id="87a71afe-d97a-7414-b496-356ae4d99764" data-wf-id="[&quot;87a71afe-d97a-7414-b496-356ae4d99764&quot;]" data-automation-id="dyn-item-diagnostics-input">Traitement par antifongique topique (<a href="https://www.ordotype.fr/ordonnances-types/candidose-geniale-vulvovaginite" target="_blank" rel="noopener">ordonnance</a>),</li><li data-w-id="bc2cc31a-dd25-1259-4aef-fd216f2c14d1" data-wf-id="[&quot;bc2cc31a-dd25-1259-4aef-fd216f2c14d1&quot;]" data-automation-id="dyn-item-diagnostics-input">Pas besoin de traiter le partenaire en l'absence de sympt&ocirc;mes,</li><li data-w-id="6cd7d9a2-708a-186a-611f-23d20cfd4576" data-wf-id="[&quot;6cd7d9a2-708a-186a-611f-23d20cfd4576&quot;]" data-automation-id="dyn-item-diagnostics-input">En cas de r&eacute;cidive fr&eacute;quentes :<ul><li data-w-id="048421f7-8e08-96b9-345a-9166344fc706" data-wf-id="[&quot;048421f7-8e08-96b9-345a-9166344fc706&quot;]" data-automation-id="dyn-item-diagnostics-input">Rechercher un facteur favorisant,</li><li data-w-id="a6633d1c-dbf3-2480-ad82-0044ece97fe5" data-wf-id="[&quot;a6633d1c-dbf3-2480-ad82-0044ece97fe5&quot;]" data-automation-id="dyn-item-diagnostics-input">Envisager un traitement au long cours.&nbsp;</li></ul></li></ul></td></tr><tr><td style="text-align: center;"><p><strong>Vaginose bact&eacute;rienne</strong></p></td><td><ul><li data-w-id="38cc841c-a098-8eb3-2c51-6788ff7aa3e1" data-wf-id="[&quot;38cc841c-a098-8eb3-2c51-6788ff7aa3e1&quot;]" data-automation-id="dyn-item-diagnostics-input">Pertes grises peu abondantes et malodorantes,</li><li data-w-id="da5224c0-5b0e-46d8-edc1-e6db440b2c94" data-wf-id="[&quot;da5224c0-5b0e-46d8-edc1-e6db440b2c94&quot;]" data-automation-id="dyn-item-diagnostics-input">Score de Nugent &eacute;lev&eacute; sur le pr&eacute;l&egrave;vement vaginal,</li><li data-w-id="a64c9fdd-f9b6-7578-8d6b-f61f4eb67d31" data-wf-id="[&quot;a64c9fdd-f9b6-7578-8d6b-f61f4eb67d31&quot;]" data-automation-id="dyn-item-diagnostics-input">Traitement par m&eacute;tronidazole (<a href="/ordonnances-types/traitement-vaginose-bacterienne" target="_blank" rel="noopener">ordonnance</a>),</li><li data-w-id="abf769a1-9ae7-439b-26ff-c8dfc3589fd0" data-wf-id="[&quot;abf769a1-9ae7-439b-26ff-c8dfc3589fd0&quot;]" data-automation-id="dyn-item-diagnostics-input">Traitement du partenaire inutile.</li></ul></td></tr><tr><td><p style="text-align: center;"><strong>Autres</strong></p></td><td><ul><li data-w-id="f9e9d865-e601-ca5b-ed91-870ebc55161a" data-wf-id="[&quot;f9e9d865-e601-ca5b-ed91-870ebc55161a&quot;]" data-automation-id="dyn-item-diagnostics-input"><strong>IST</strong> (<a href="https://www.ordotype.fr/pathologies/infections-sexuellement-transmissibles-ist-mst" target="_blank" rel="noopener">voir la fiche</a>),</li><li data-w-id="3fb4ad5b-5c5a-42ca-e6b9-907161dc21f7" data-wf-id="[&quot;3fb4ad5b-5c5a-42ca-e6b9-907161dc21f7&quot;]" data-automation-id="dyn-item-diagnostics-input">Corps &eacute;tranger intravaginal,</li><li data-w-id="9d8f44f9-d793-ba3b-4199-71b092660e3b" data-wf-id="[&quot;9d8f44f9-d793-ba3b-4199-71b092660e3b&quot;]" data-automation-id="dyn-item-diagnostics-input">N&eacute;oplasie,</li><li data-w-id="35954b04-7e0c-6dfd-f85b-e14e9561e0a6" data-wf-id="[&quot;35954b04-7e0c-6dfd-f85b-e14e9561e0a6&quot;]" data-automation-id="dyn-item-diagnostics-input">Atrophie par carence hormonale (femme m&eacute;nopaus&eacute;e),</li><li data-w-id="35954b04-7e0c-6dfd-f85b-e14e9561e0a6" data-wf-id="[&quot;35954b04-7e0c-6dfd-f85b-e14e9561e0a6&quot;]" data-automation-id="dyn-item-diagnostics-input">Jeune fille :<ul><li data-w-id="35954b04-7e0c-6dfd-f85b-e14e9561e0a6" data-wf-id="[&quot;35954b04-7e0c-6dfd-f85b-e14e9561e0a6&quot;]" data-automation-id="dyn-item-diagnostics-input">Vulvovaginite &agrave; germes banals (<em>S. pyogenes</em>),</li><li data-w-id="35954b04-7e0c-6dfd-f85b-e14e9561e0a6" data-wf-id="[&quot;35954b04-7e0c-6dfd-f85b-e14e9561e0a6&quot;]" data-automation-id="dyn-item-diagnostics-input">Oxyurose,</li><li data-w-id="35954b04-7e0c-6dfd-f85b-e14e9561e0a6" data-wf-id="[&quot;35954b04-7e0c-6dfd-f85b-e14e9561e0a6&quot;]" data-automation-id="dyn-item-diagnostics-input">Corps &eacute;tranger intravaginal</li></ul></li></ul></td></tr></tbody></table><p>&nbsp;</p><table border="1" cellpadding="5"><caption>Tableau 2 - Infection g&eacute;nitales hautes (hors post-partum)</caption><tbody><tr><th colspan="2"><strong data-w-id="238f8bbb-f0a4-3b9b-1497-50ad7b1a4c8a" data-wf-id="[&quot;238f8bbb-f0a4-3b9b-1497-50ad7b1a4c8a&quot;]" data-automation-id="dyn-item-diagnostics-input">Infections g&eacute;nitales hautes</strong></th></tr><tr><td style="background-color: #bef2d3; text-align: center;" colspan="2"><strong>G&eacute;n&eacute;ralit&eacute;s</strong></td></tr><tr><td><p style="text-align: center;"><strong>Principaux germes</strong></p></td><td><ul><li data-w-id="0e1c9bdc-bd7e-1d30-c83d-3b5073ab21fb" data-wf-id="[&quot;0e1c9bdc-bd7e-1d30-c83d-3b5073ab21fb&quot;]" data-automation-id="dyn-item-diagnostics-input">Germes des IST,</li><li data-w-id="d0fe7efa-2182-aab1-a7e5-ade6455b0e0d" data-wf-id="[&quot;d0fe7efa-2182-aab1-a7e5-ade6455b0e0d&quot;]" data-automation-id="dyn-item-diagnostics-input">Germes opportunistes issus de la flore vaginale,</li><li data-w-id="14f24e6e-b32b-ea7b-eaca-712044ed3872" data-wf-id="[&quot;14f24e6e-b32b-ea7b-eaca-712044ed3872&quot;]" data-automation-id="dyn-item-diagnostics-input">Exceptionnellement : tuberculose ou bilharziose.</li></ul></td></tr><tr><td style="background-color: #bef2d3; text-align: center;" colspan="2"><strong>Diagnostic positif</strong></td></tr><tr><td style="text-align: center;"><p><strong>Clinique</strong></p></td><td><ul><li data-w-id="80079081-40a8-559b-3944-d528949fc393" data-wf-id="[&quot;80079081-40a8-559b-3944-d528949fc393&quot;]" data-automation-id="dyn-item-diagnostics-input">Douleurs pelviennes / dyspareunies,</li><li data-w-id="741ca1e2-0460-a43a-cbaa-dcb341b2bd7d" data-wf-id="[&quot;741ca1e2-0460-a43a-cbaa-dcb341b2bd7d&quot;]" data-automation-id="dyn-item-diagnostics-input">Leucorrh&eacute;es pathologiques,</li><li data-w-id="9c51f569-a6b5-903d-e236-82f1598771a5" data-wf-id="[&quot;9c51f569-a6b5-903d-e236-82f1598771a5&quot;]" data-automation-id="dyn-item-diagnostics-input">Douleurs &agrave; la mobilisation ut&eacute;rine au toucher vaginal,</li><li data-w-id="0ce031d1-5abe-68b2-b56a-7f831e58c83e" data-wf-id="[&quot;0ce031d1-5abe-68b2-b56a-7f831e58c83e&quot;]" data-automation-id="dyn-item-diagnostics-input">+/- M&eacute;trorragies,</li><li data-w-id="295597d2-fcd7-6375-ead5-cd6a3ad8b41c" data-wf-id="[&quot;295597d2-fcd7-6375-ead5-cd6a3ad8b41c&quot;]" data-automation-id="dyn-item-diagnostics-input">+/- Douleurs dans les culs-de-sac vaginaux,</li><li data-w-id="46e0ba4b-05ba-5850-7825-1470b52d6ca0" data-wf-id="[&quot;46e0ba4b-05ba-5850-7825-1470b52d6ca0&quot;]" data-automation-id="dyn-item-diagnostics-input">+&nbsp;/- Signes fonctionnels urinaires,</li><li data-w-id="921b72e4-cb2e-67be-f74e-3d8755ec2dd6" data-wf-id="[&quot;921b72e4-cb2e-67be-f74e-3d8755ec2dd6&quot;]" data-automation-id="dyn-item-diagnostics-input">Absence de signes g&eacute;n&eacute;raux ou d'irritation p&eacute;riton&eacute;ales, dans les formes non compliqu&eacute;es,</li><li data-w-id="eb601134-f092-3c3e-59ca-7509c6ec74c3" data-wf-id="[&quot;eb601134-f092-3c3e-59ca-7509c6ec74c3&quot;]" data-automation-id="dyn-item-diagnostics-input">Absence de d&eacute;fense ou de contracture (m&ecirc;me si des douleurs abdominales peuvent exister, doivent faire &eacute;voquer une complication).</li></ul></td></tr><tr><td style="text-align: center;"><p><strong>Paraclinique</strong></p></td><td><ul><li data-w-id="de86e4ed-fab0-d5de-4f58-96d6abaf55da" data-wf-id="[&quot;de86e4ed-fab0-d5de-4f58-96d6abaf55da&quot;]" data-automation-id="dyn-item-diagnostics-input">Biologiques (<a href="https://www.ordotype.fr/ordonnances-types/prelevements-endocervical-infections-genitales-hautes" target="_blank" rel="noopener">ordonnance</a>) :<ul><li data-w-id="7fa2af8a-89db-86a7-f913-ae3a3584a97a" data-wf-id="[&quot;7fa2af8a-89db-86a7-f913-ae3a3584a97a&quot;]" data-automation-id="dyn-item-diagnostics-input">NFS, CRP : normaux en cas de forme non compliqu&eacute;e,</li><li data-w-id="e9431900-b93d-cb6c-aa3d-67f242fa50ed" data-wf-id="[&quot;e9431900-b93d-cb6c-aa3d-67f242fa50ed&quot;]" data-automation-id="dyn-item-diagnostics-input">Beta-HCG,</li><li data-w-id="4beac824-face-4491-dc0e-bbdfa85b090a" data-wf-id="[&quot;4beac824-face-4491-dc0e-bbdfa85b090a&quot;]" data-automation-id="dyn-item-diagnostics-input">ECBU,</li><li data-w-id="f5d70ba3-2b69-45fb-cdb9-60c0e20780ed" data-wf-id="[&quot;f5d70ba3-2b69-45fb-cdb9-60c0e20780ed&quot;]" data-automation-id="dyn-item-diagnostics-input">PCR Chlamydiae, gonocoque, mycoplasmes,</li><li data-w-id="30a44a84-cb48-a70b-655d-89054a0c49b6" data-wf-id="[&quot;30a44a84-cb48-a70b-655d-89054a0c49b6&quot;]" data-automation-id="dyn-item-diagnostics-input">Pr&eacute;l&egrave;vement endocervical en cas de suspicion d'infection g&eacute;nitale haute (auto-pr&eacute;l&egrave;vement vaginal en 2<sup>&egrave;me</sup> choix, si pr&eacute;l&egrave;vement guid&eacute; par sp&eacute;culum impossible),</li><li data-w-id="f7cae078-9277-ad60-ab54-558041ea7717" data-wf-id="[&quot;f7cae078-9277-ad60-ab54-558041ea7717&quot;]" data-automation-id="dyn-item-diagnostics-input">Mise en culture d'un &eacute;ventuel st&eacute;rilet.</li></ul></li><li data-w-id="a55639d7-1d3a-e063-c11e-691249cb8030" data-wf-id="[&quot;a55639d7-1d3a-e063-c11e-691249cb8030&quot;]" data-automation-id="dyn-item-diagnostics-input">Echographie pelvienne (<a href="https://www.ordotype.fr/ordonnances-types/echographie-infection-genitale-haute" target="_blank" rel="noopener">ordonnance</a>) :<ul><li data-w-id="a55639d7-1d3a-e063-c11e-691249cb8030" data-wf-id="[&quot;a55639d7-1d3a-e063-c11e-691249cb8030&quot;]" data-automation-id="dyn-item-diagnostics-input">recherche de complications ou</li><li data-w-id="a55639d7-1d3a-e063-c11e-691249cb8030" data-wf-id="[&quot;a55639d7-1d3a-e063-c11e-691249cb8030&quot;]" data-automation-id="dyn-item-diagnostics-input">de diagnostic diff&eacute;rentiel.&nbsp;</li></ul></li><li data-w-id="76d8b577-fd7b-6b34-7ac1-8997931ec7f0" data-wf-id="[&quot;76d8b577-fd7b-6b34-7ac1-8997931ec7f0&quot;]" data-automation-id="dyn-item-diagnostics-input">En cas de doute avec un diagnostic diff&eacute;rentiel : TDM, IRM voir coelioscopie.</li></ul></td></tr><tr><td style="text-align: center;"><p><strong>Complications</strong></p></td><td><ul><li data-w-id="3f45abd5-0707-2a86-ddd7-ad2bccb07e39" data-wf-id="[&quot;3f45abd5-0707-2a86-ddd7-ad2bccb07e39&quot;]" data-automation-id="dyn-item-diagnostics-input">Aigu&euml;s <strong>(Hospitalisation pour pr&eacute;l&egrave;vements chirurgicaux ou &eacute;choguid&eacute;s)</strong> :<ul><li data-w-id="3f8ef4b9-6a53-0ab3-49e7-7a8de49b723f" data-wf-id="[&quot;3f8ef4b9-6a53-0ab3-49e7-7a8de49b723f&quot;]" data-automation-id="dyn-item-diagnostics-input">Pelvi-p&eacute;ritonites,</li><li data-w-id="4c56446b-1d21-fb6b-a30f-7946c9a8de75" data-wf-id="[&quot;4c56446b-1d21-fb6b-a30f-7946c9a8de75&quot;]" data-automation-id="dyn-item-diagnostics-input">Abc&egrave;s pelvien.</li></ul></li><li data-w-id="5c70d4b2-8bd2-e926-5e71-b60897dba1df" data-wf-id="[&quot;5c70d4b2-8bd2-e926-5e71-b60897dba1df&quot;]" data-automation-id="dyn-item-diagnostics-input">&Agrave; long terme :<ul><li data-w-id="0572913d-5d3f-ef9c-8fb0-061a015f486f" data-wf-id="[&quot;0572913d-5d3f-ef9c-8fb0-061a015f486f&quot;]" data-automation-id="dyn-item-diagnostics-input">Infertilit&eacute;,</li><li data-w-id="720d12f4-8350-6b4e-8616-ca4aba40718f" data-wf-id="[&quot;720d12f4-8350-6b4e-8616-ca4aba40718f&quot;]" data-automation-id="dyn-item-diagnostics-input">GEU,</li><li data-w-id="5b82d2e3-196a-43ae-0040-a58fe4155174" data-wf-id="[&quot;5b82d2e3-196a-43ae-0040-a58fe4155174&quot;]" data-automation-id="dyn-item-diagnostics-input">Douleurs pelviennes chroniques.</li></ul></li></ul></td></tr><tr><td style="background-color: #bef2d3; text-align: center;" colspan="2"><strong>Traitement</strong></td></tr><tr><td style="text-align: center;"><p><strong>G&eacute;n&eacute;ralit&eacute;s</strong></p></td><td><p><strong>D&eacute;buter sans attendre les r&eacute;sultats des examens.</strong></p><ul><li data-w-id="4329d0c2-c115-1e2d-049e-18a3163b6e08" data-wf-id="[&quot;4329d0c2-c115-1e2d-049e-18a3163b6e08&quot;]" data-automation-id="dyn-item-diagnostics-input">Seules les formes non compliqu&eacute;es peuvent &ecirc;tre prises en charge en ambulatoire, les autres doivent &ecirc;tre hospitalis&eacute;es en urgence.&nbsp;</li><li data-w-id="768e4093-d65c-af54-ab02-fa77165646ca" data-wf-id="[&quot;768e4093-d65c-af54-ab02-fa77165646ca&quot;]" data-automation-id="dyn-item-diagnostics-input">Traitement de la patiente et du partenaire et protection des rapports en cas d'IST,</li><li data-w-id="0e2f2397-adba-5110-3c33-fd8a0e306f54" data-wf-id="[&quot;0e2f2397-adba-5110-3c33-fd8a0e306f54&quot;]" data-automation-id="dyn-item-diagnostics-input">Retrait d'un DIU non syst&eacute;matique mais &agrave; discuter (avis sp&eacute;cialis&eacute;),</li><li data-w-id="4d599ac2-1e27-d07d-eed9-e007530d0c6f" data-wf-id="[&quot;4d599ac2-1e27-d07d-eed9-e007530d0c6f&quot;]" data-automation-id="dyn-item-diagnostics-input">Traitement symptomatique,</li><li data-w-id="4d599ac2-1e27-d07d-eed9-e007530d0c6f" data-wf-id="[&quot;4d599ac2-1e27-d07d-eed9-e007530d0c6f&quot;]" data-automation-id="dyn-item-diagnostics-input">R&eacute;&eacute;valuation syst&eacute;matique &agrave; 3-6 mois pour v&eacute;rifier l'absence de r&eacute;cidive</li></ul></td></tr><tr><td style="text-align: center;"><strong>Forme non compliqu&eacute;e</strong></td><td><ul><li>Traitement ambulatoire possible</li><li>Hospitalisation si forme non compliqu&eacute;e interm&eacute;diaire :<ul><li>Doute diagnostique,</li><li>Sympt&ocirc;mes tr&egrave;s intenses,</li><li>Difficult&eacute; de prise des antibiotiques oraux,</li><li>&Eacute;chec d'un traitement ant&eacute;rieur,</li><li>D&eacute;tresse psychosociale.</li></ul></li><li>Antibioth&eacute;rapie (<a href="https://www.ordotype.fr/ordonnances-types/infection-genitale-haute" target="_blank" rel="noopener">ordonnance</a>) :<ul><li data-w-id="07e37eb2-173d-6d69-0182-f180c24944c2" data-wf-id="[&quot;07e37eb2-173d-6d69-0182-f180c24944c2&quot;]" data-automation-id="dyn-item-diagnostics-input">Ceftriaxone dose unique IM (<a href="https://www.ordotype.fr/ordonnances-types/ide-ceftriaxone-infection-genitale-haute" target="_blank" rel="noopener">ordonnance injection par IDE</a>), ET</li><li data-w-id="937d1e80-f46a-8495-13a8-cee8ddb954f6" data-wf-id="[&quot;937d1e80-f46a-8495-13a8-cee8ddb954f6&quot;]" data-automation-id="dyn-item-diagnostics-input">Doxycycline 10 jours, ET</li><li data-w-id="a5a86034-93af-b82f-bd6f-49b3380f64d9" data-wf-id="[&quot;a5a86034-93af-b82f-bd6f-49b3380f64d9&quot;]" data-automation-id="dyn-item-diagnostics-input">M&eacute;tronidazole 10 jours</li></ul></li><li data-w-id="a3ba6a59-0a47-17f2-5af8-9cf59cf35036" data-wf-id="[&quot;a3ba6a59-0a47-17f2-5af8-9cf59cf35036&quot;]" data-automation-id="dyn-item-diagnostics-input">Revoir obligatoirement entre 3 et 5 jours pour juger de l'&eacute;volution et v&eacute;rifier l'observance,</li><li>Retrait d'un DIU non syst&eacute;matique mais &agrave; discuter (avis sp&eacute;cialis&eacute;).</li></ul></td></tr><tr><td style="text-align: center;"><strong>Forme compliqu&eacute;e</strong></td><td><ul><li><strong>Hospitalisation en urgence</strong></li><li><strong><strong>Drainage chirurgical ou radioguid&eacute; des abc&egrave;s &gt; 3-4 cm</strong></strong></li><li><strong><strong>Antibioth&eacute;rapie :</strong></strong><ul><li data-w-id="07e37eb2-173d-6d69-0182-f180c24944c2" data-wf-id="[&quot;07e37eb2-173d-6d69-0182-f180c24944c2&quot;]" data-automation-id="dyn-item-diagnostics-input">Ceftriaxone 1-2 g/j (2 g si signes de gravt&eacute; ou poids &gt; 80kg) IV, jusqu'&agrave; am&eacute;lioration, ET</li><li data-w-id="937d1e80-f46a-8495-13a8-cee8ddb954f6" data-wf-id="[&quot;937d1e80-f46a-8495-13a8-cee8ddb954f6&quot;]" data-automation-id="dyn-item-diagnostics-input">Doxycycline 14 jours, ET</li><li data-w-id="a5a86034-93af-b82f-bd6f-49b3380f64d9" data-wf-id="[&quot;a5a86034-93af-b82f-bd6f-49b3380f64d9&quot;]" data-automation-id="dyn-item-diagnostics-input">M&eacute;tronidazole 14 jours</li></ul></li><li data-w-id="a3ba6a59-0a47-17f2-5af8-9cf59cf35036" data-wf-id="[&quot;a3ba6a59-0a47-17f2-5af8-9cf59cf35036&quot;]" data-automation-id="dyn-item-diagnostics-input">Retrait d'un DIU.</li></ul></td></tr></tbody></table>‍

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