Bacteriology and treatment of malodorous lower reproductive tract in gynecologic cancer patients

Objective: To determine the bacteriology of lower genital tract cancers to direct potential treatment modalities and to determine the impact of treatm ent on quality of life. Methods: Gram stain, saline preparations, tumor pH determinations, and anae robic and aerobic tumor cultures were obtained from 13 consecutive patients with malodorous gynecologic cancers and 13 patients (controls) with non-ma lodorous tumors. All patients with odor were treated with topical metronida zole for 7 days. Odor assessment questionnaires were administered daily in the treatment group. Quality-of-life evaluation was assessed using the Func tional Assessment of Cancer Therapy questionnaire before and after treatmen t. Results: Cancer of the cervix (n = 21) was the most common primary site and accounted for 81% (95% confidence interval 61%, 93%) of malodorous gynecol ogic cancers. Eight of 13 (62%) patients with malodorous tumors had bacteri al vaginosis compared with four of 13 (31%) of those without odor (P =.11). Aerobic and anaerobic bacteria were isolated with equal frequency from mal odorous gynecologic cancers. Results of odor assessment questionnaires show ed a graded improvement with topical antibiotic therapy (P <.001). The Func tional Assessment of Cancer Therapy questionnaire indicated improved qualit y of life after therapy (P =.02). Conclusion: Most patients with odor had bacterial vaginosis and had an impr ovement in odor with topical metronidazole. Therefore, this treatment might be useful for patients with malodorous pelvic tumors. (Obstet Gynecol 2000 ; 96:23-7. (C) 2000 by The American College of Obstetricians and Gynecologi sts.).