BV vs. Yeast Infection: How to Tell the Difference
Bacterial vaginosis (BV) vs. yeast infection symptoms can be difficult to parse—they’re very similar, which can make them challenging to correctly self diagnose.
That’s why we’re breaking down BV and yeast infection symptoms, causes, and treatments in this detailed guide. We’ll also touch on how to tell the difference between BV and a vaginal yeast infection and discuss when to see a provider or seek online yeast infection treatment.
What Is Bacterial Vaginosis (BV)?
Let’s start with bacterial vaginosis (BV). BV is a very common vaginal health condition, but contrary to popular belief, bacterial vaginosis is not a sexually transmitted infection (STI). [1] Let’s dive into the specifics.
Causes of BV
BV occurs when certain strains of harmful bacteria become too concentrated in your vaginal microbiome. [2] While causes are generally unknown, health researchers are studying:
- Which bacteria are at play in BV – BV used to be called Gardnerella vaginitis because healthcare experts assumed that Gardnerella bacteria was the only vaginal flora strain to blame for BV symptoms. [1] However, modern research has since debunked this—overgrowth of multiple strains of bad bacteria can cause BV. Once researchers discovered that multiple bacteria strains could cause BV, the name was changed to reflect a more generalized diagnosis. [1]
- Why BV can be spread via sex – BV can be spread via sexual activity, especially in same-sex couples, but it’s also common among people who aren’t sexually active. [2] Researchers aren’t precisely sure which bacterial exchanges cause BV transmission, but research is ongoing. [1]
- Why BV reoccurs – Unfortunately, approximately 80% of people who get BV will get it again shortly after they’ve been treated. [1] Since antibiotics are regarded as a generally effective treatment for recurring BV, this raises research questions about bacterial growth, antibiotic resistance, and more.
BV Symptoms
Many people with BV have no symptoms—if this is the case, you may not even know that you have BV. [2]
However, if you do have symptoms, they may include [2]:
- Vaginal inflammation and irritation
- A burning sensation while urinating
- Itching throughout the vulva (area outside the vagina)
- Vaginal discharge that’s different than usual, especially if gray and fishy smelling
Symptoms also vary in severity from person to person. [2] While some people may experience only mild itching and slightly abnormal discharge, others may have symptoms that affect their quality of life.
Interestingly, these symptoms are almost identical to those of a yeast infection; this is why these two distinct infections are difficult to self-diagnose. [2]
One of the hallmark signs of BV is the unique discharge characteristics patients often experience. We’ll explore how BV discharge differs from yeast infection discharge in a later section.
BV Treatment
Many untreated BV cases go away on their own. This happens when the good and harmful bacteria in the vagina rebalance on their own. [1]
For cases that don’t clear up on their own (or for patients with severe symptoms), providers use one or both of the following treatments for BV:
1. Antibiotics
– Healthcare providers typically prescribe either clindamycin or metronidazole for BV cases. [1] They’re both well-tolerated and safe to take when you’re pregnant. The latter characteristic is very important: about 25% of pregnant people get BV at some point during their pregnancy. [2]2. Boric acid suppositories
– In cases where antibiotics don’t completely clear up BV, providers may recommend using boric acid suppositories. [3] This might sound surprising—after all, boric acid is toxic when ingested and can cause skin irritation. However, when used as a vaginal suppository only, it can help your vaginal biome return to balance. [3] While they’re a widely-used option for recurring BV cases in the US, boric acid suppositories are still not FDA-approved. [3]What is a Yeast Infection?
Before we compare BV vs. yeast infections, let’s cover the latter in more detail.
Causes of a Yeast Infection
A vaginal yeast infection is, like BV, a condition caused by overgrowth of certain organisms (germs) in the vaginal biome. [4] However, instead of bacteria, a vaginal yeast infection is caused by a fungus called Candida. [4]
Candida fungi are found throughout the body (and in the vagina), but they don’t cause any issues as long as they don’t overtake other bacteria. Concentration is key. [5]
Bacterial and fungal imbalance commonly occurs in people who: [5]
- Have diabetes
- Struggle with immune suppression
- Take specific medications, including:
- Steroids
- Hormone therapy
- Antibiotics
- Cancer drugs
Once yeast begins to overgrow, certain lifestyle factors can increase Candida overgrowth [5]:
- Wearing tight pants or non-breathable fabrics
- Using pH-disrupting soaps or perfumed products inside the vagina
- Sweating while working out
Yeast Infection Symptoms
Some yeast infections don’t cause symptoms. However, if you do have symptoms, the first thing you’re most likely to notice is itching—even mild yeast infections are itchy. [4]
Other symptoms include:
- Burning, swelling, and redness in the vagina and vulvar area
- Painful urination
- Pain during sex
- Genital soreness
- Unusual discharge, especially if it’s thick, white, and chunky
Do some of these sound familiar? Almost all of them overlap with common BV symptoms. This may be because BV and yeast infections are the same kind of condition: a clinically significant biome imbalance. [1,5]
Yeast Infection Treatment
One reason why it’s so important to correctly diagnose BV and yeast infections is the difference in treatment: antibiotics prescribed for BV won’t clear up a yeast infection and vice versa. [2,4]
Instead, yeast infections are most commonly treated with antifungal medications. [4] Here are a few things to know about antifungals:
Some don’t require a prescription – Depending on the severity of your infection, your provider may recommend using only over-the-counter antifungal formulas. These are available as tablets, creams, ointments, and vaginal suppositories. [4]
Some are prescribed by a provider – Some providers may prescribe a one-dose antifungal medication like fluconazole. [4]
They may be used long term for recurring cases – If you get multiple yeast infections every year, your provider may recommend taking a regular dose of prescription antifungal medication for a few months or until your biome returns to normal. It’s especially important to seek out a provider if you have recurring vaginal infections. For a more convenient option, you can also look into getting yeast infection treatment online.
You may have noticed that antibiotic medications can increase your risk of yeast infections—unfortunately, antibiotics prescribed for BV aren’t exempt. [6] However, only about 10% of people prescribed clindamycin or metronidazole get a yeast infection after their BV treatment. [6]
Telling the Difference Between BV and a Yeast Infection
Despite their similar symptoms, two telltale signs set a yeast infection apart from BV—let’s break down each one to help you correctly self-diagnose.
1. Discharge Quality
BV and yeast infections can both cause abnormal vaginal discharge, but the characteristics of these discharges are different.Discharge caused by BV is typically [2]:
- White or gray in color
- Foamy or watery in texture
- Strong-smelling
Patients commonly report that the unusual odor is the strongest after having sex. [2]
On the other hand, discharge caused by a yeast infection is usually [4]:
- White
- Thick or lumpy in texture
- Odor-free
Many patients compare yeast infection discharge to cottage cheese. But instead of leaning on this comparison to try to self-diagnose, consider the symptoms of both BV and yeast infection discharge when making your best guess about your condition.
2. Odors
While we mentioned this briefly above, the unusual vaginal discharge associated with BV and yeast infections doesn’t just look and feel different—it also smells different.Put simply, yeast infections don’t typically impact your vaginal odor. [4] While you might notice some slight differences, yeast infection discharge usually doesn’t smell out of the ordinary.
BV discharge, on the other hand, often presents with a strong smell. [2] While it’s often compared to a fishy smell, keep in mind that everyone has a different perception of odor—if your discharge smells abnormal compared to your usual odor, this could be a sign of a vaginal infection.
Not sure if your discharge smells the same as usual? While it might sound embarrassing, consider asking your partner if they’ve noticed an unusual smell during or after having sex. If you’ve been having mild symptoms for some time, you might be accustomed to any differences in smell—so you may not notice changes like these. Your partner, however, may be able to provide helpful observations.
When to See a Provider
So, you’ve noticed a change in your discharge and you’re itching non-stop—when should you make an appointment with your vaginal healthcare provider?
While it might not be the answer you’re hoping for, you should follow up with a provider as soon as you notice any vaginal abnormalities. Why?
Yeast infections and BV are difficult to diagnose – While you can purchase over-the-counter antifungal medications for a yeast infection, these simply won’t work if you actually have BV. To make sure you use the right intervention the first time, see a healthcare provider to confirm your diagnosis.
Both conditions can lead to complications – Both BV and yeast infections can lead to other health issues—like contracting STIs. [1,4] In fact, it’s especially risky to leave BV untreated as doing so can increase your risk of contracting HIV or other STIs. [1,2]
You might have a different condition – It’s possible that your symptoms don’t indicate BV or a yeast infection—you could have a completely different (and potentially more serious) condition altogether. Instead of wasting valuable treatment time trying to clear up a condition you don’t have, visit your provider for concrete answers as soon as you can.
Everlywell: Your Connection to Vaginal Health at Home
When in doubt about your vaginal health, there’s a convenient, accessible, and affordable way to ease your worries and get the treatment you need: virtual care visits with Everlywell.
Everlywell is making it easier than ever to access the healthcare you need, all from the comfort of your home. We connect patients like you with experienced, empathetic, and licensed providers who can personalize care plans to meet your unique needs.
Ready to say hello to an easier care path? Make your first virtual care appointment with Everlywell today.
References
- Kairys N. Bacterial vaginosis. StatPearls. Accessed May 15, 2024. Medical Citation URL.
- Bacterial vaginosis. Office on Women’s Health. Accessed May 15, 2024. Medical Citation URL.
- Mittelstaedt R, Kretz A, Levine M, et al. Data on safety of intravaginal boric acid use in pregnant and nonpregnant women: A narrative review. Sexually Transmitted Diseases. 2021;48(12). doi:10.1097/olq.0000000000001562. Medical Citation URL.
- Vaginal yeast infections. Office on Women’s Health. Accessed May 15, 2024. Medical Citation URL.
- Overview: Vaginal yeast infection (thrush). InformedHealth.org. Accessed May 15, 2024. Medical Citation URL.
- Bacterial vaginosis: Learn more – which treatments are effective in bacterial vaginosis? InformedHealth.org. Accessed May 15, 2024. Medical Citation URL.