Reliability of the whiff test in clinical practice.

Vaginitis is among the most common reasons for gynecological consultation in primary care. Although the work-up of vaginal symptoms is well described in the literature, women often go without a diagnosis, and a recent study using cultures as a gold standard found that clinician diagnoses were not very accurate. Bacterial vaginosis (BV) is the most common cause of vaginitis in patients presenting to health care providers. The diagnosis of BV rests on four criteria, one of which is the “whiff test.” The whiff test is performed by mixing a sample of vaginal discharge with potassium hydroxide and smelling the sample for a characteristic fishy odor. Although the whiff test is one of the most common clinical tests in primary care, its reliability has never been assessed. We undertook this study to determine if the whiff test was a reliable diagnostic maneuver as measured by interobserver variability.