Bacterial Vaginosis or Yeast Infection?

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Bacterial vaginosis (BV) and yeast infections are both common types of vaginal infections.

Even though they have some symptoms in common, BV is caused by bacteria while yeast infections are caused by fungus. There are both over-the-counter (OTC) and prescription treatments available for yeast infections, but for BV you need a prescription.

Keep reading to learn more about the symptoms, causes, treatment, and tips to prevent both BV and yeast infections.

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Symptoms

The symptoms of BV and vaginal yeast infections resemble each other closely. This makes it difficult for you to know which type of infection you are dealing with.

The appearance and smell of vaginal discharge help to distinguish between the two.

Yeast infections normally don’t change the smell of vaginal discharge while BV typically causes a strong fish-like odor.

With yeast infections, the vaginal discharge typically becomes thick, white, and cottage cheese-like in appearance. Bacterial vaginosis discharge usually takes on a thinner texture that is grayish-white in color.

Another difference in symptoms is that BV typically doesn’t cause redness or swelling in and around the vagina, while yeast infections do.

Below is more information about common symptoms of bacterial vaginosis vs. yeast infections.

BV
  • Thin, grayish-white vaginal discharge


  • A strong “fishy” odor, often more noticeable after sex or while menstruating


  • Discomfort


  • Irritation


  • Itching and burning sensations


Yeast Infection
  • Thick, white, and lumpy discharge that may resemble cottage cheese


  • Irritation or itching


  • Burning sensations during sex or urinating


  • Redness and swelling around the vagina or vulva


Causes

While some of the symptoms of BV and yeast infections overlap, the cause of each is completely different.

BV

BV is a bacterial infection caused by an imbalance in your microbiome or vaginal flora around and inside your vagina.

Bacteria and other microorganisms thrive best in their favorite environments. Any changes to the environment can cause one type of bacteria to grow out of control, leading to infection.

BV is commonly caused by changes in pH levels (how acidic the environment is).

When the acidity changes, the number of lactic acid bacteria drops. This type of bacteria helps maintain the balance of healthy vaginal flora and when the number of lactic acid bacteria goes down, other kinds of bacteria grow more easily.

The bacteria responsible for most BV infections is Gardnerella vaginalis.

What Affects Vaginal pH?

Your vaginal pH can be affected by:

  • Frequent sexual intercourse
  • New or multiple sex partners
  • Vaginal douching
  • Hormone changes, like hormonal birth control, menstruating, pregnancy, and menopause

Yeast Infection

Yeast infections are caused by fungus. When the pH and environment changes, there is a chance yeast will overgrow.

The type of yeast or fungus responsible for yeast infections is Candida.

Risk factors for Candida overgrowth include:

  • Hormone changes from menstruating, pregnancy, or hormonal birth control
  • Diabetes and high blood sugar
  • Weakened immune system, such as during cancer treatment or with conditions like HIV
  • Antibiotics

Diagnosis

If you aren’t sure which type of infection you have, it’s best to take a trip to the doctor. It can be difficult to tell the difference between the types of vaginal infections and finding the cause is important for proper treatment.

If this is your first time experiencing a yeast infection, it’s best to go to the doctor to get an accurate diagnosis.

During your appointment, your doctor may:

  • Gather a history of your symptoms
  • Perform a pelvic exam
  • Take a sample of vaginal discharge to test for pH level and bacterial or yeast overgrowth

Treatment

With the different causes of infection, different medications are needed to treat BV and yeast infections. The strength, type, and length of treatment will depend on the severity of the infection.

Whatever treatment option you use, be sure to follow the directions and complete the full treatment course. If you stop partway through your treatment, the infection might not completely clear.

BV

Bacterial vaginosis is treated with antibiotics in either pill, gel, or cream form. This typically requires a trip to the doctor’s office to get a prescription for antibiotics.

BV can be treated with:

  • Metronidazole: An oral pill or gel inserted into the vagina
  • Clindamycin: A cream inserted with an applicator into the vagina or an oral pill
  • Tinidazole: An oral pill

Yeast Infection

Antifungal medications are used to treat yeast infections. Unlike BV, there are both over-the-counter (OTC) medications and prescription medications available to treat yeast infections. These include:

  • Fluconazole: A prescription oral antifungal medication, typically prescribed as a single dose.
  • Terconazole or miconazole: Available as creams and suppositories applied to and inside the vagina. These are available over the counter or as prescriptions.
  • Clotrimazole: In a class of antifungal medications called imidazoles. It works by stopping the growth of fungi that cause infection.
  • Tioconazole: It comes as a cream and suppository to insert into the vagina.
  • Butoconazole: It comes as a cream to insert into the vagina. It is usually used daily at bedtime.

Prevention

Vaginal infections are common, but there are steps you can take to reduce the risks of them coming back.

The following tips may help prevent BV and yeast infections:

  • Wear loose fitting clothing and cotton underwear to reduce moisture
  • Limit time spent in hot baths or hot tubs
  • Avoid douching, especially with scented products
  • Eat a nutritious diet and probiotic foods
  • Change out of workout clothes wet from sweat and bathing suits immediately

A Word From Verywell

Bacterial vaginosis and yeast infections are easy to confuse because of their similar symptoms. But the treatment needed to clear the infection is vastly different. Yeast infections can be treated with over-the-counter antifungal medications, while BV typically requires a prescription from a doctor for an antibiotic.

If you aren’t sure what is causing your infection or if it returns, talk with your doctor. You may need a stronger medication, or you may be treating for the wrong type of infection. 

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Article Sources
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  2. MedlinePlus. Yeast infections. Updated July 19, 2017.

  3. Paladine HL, Desai UA. Vaginitis: diagnosis and treatmentAm Fam Physician. 2018;97(5):321-329.

  4. Centers for Disease Control and Prevention. Vaginal candidiasis. Updated November 10, 2020.

  5. Centers for Disease Control and Prevention. Bacterial vaginosis. Updated June 4, 2015.