REPRODUCtIVE HEALTH

Bacterial Vaginosis vs. Yeast Infection: How to Tell the Difference

by MICHELLE KONSTANTINOVSKY

You’re itchy, you’re uncomfortable, and you know something isn’t right in your netherregions. But before you go self-diagnosing, consider this: two super common forms of vaginal inflammation (aka vaginitis) tend to present with very similar symptoms but require very different treatments. Here’s how to tell the difference between bacterial vaginosis and a yeast infection — and how to get better fast no matter what you’ve got. 

What is bacterial vaginosis?

Bacterial vaginosis (BV) is a type of vaginal inflammation that occurs when something disrupts the vagina’s natural bacterial balance, leading to an overgrowth of “bad” kinds of bacteria called anaerobes. BV is unbelievably common — in fact, it’s the most common cause of vaginal symptoms among women, affecting about 29 percent of women between the ages of 14-49. The resulting inflammation usually isn’t dangerous, and at least half of women who develop BV don’t even experience noticeable symptoms. But when the symptoms do become noticeable, they can be really unpleasant. A few of the signature symptoms include:

  • A “fishy” odor that becomes stronger during your period or after sex
  • Thin vaginal discharge that’s gray, yellow, or greenish 
  • Vaginal itching
  • A burning sensation with urination

What is a yeast infection?

A yeast infection is — you guessed it — a type of vaginal infection, but this form of vaginitis is the result of a fungus, not bacteria. Also known as vaginal candidiasis, vaginal yeast infections are incredibly common: about 3 out of 4 women experience them at some point in their lives, and many experience at least two. The symptoms can appear very similar to those of BV, but with some important distinctions:

  • Vaginal itching and/or irritation of the vulva
  • Pain and soreness 
  • Thick, white vaginal discharge that’s odor-free and resembles cottage cheese
  • Vaginal discharge with a watery consistency
  • A burning sensation with urination and/or sex
  • Redness and swelling of the vulva

The causes of BV and yeast infections

While BV and yeast infections share many similarities symptom-wise, the two infections have very different causes. In the case of BV, something typically has to disrupt the vagina’s natural bacterial balance. When everything is at it should be, the “good” bacteria (lactobacilli) outnumber the “bad” bacteria (anaerobes). But if something comes along and disrupts the vaginal environment, BV can develop. A few of the most common causes of that disruption:

  • Douching or excessive cleaning of the vagina
  • Hormonal changes that accompany events like menstruation, pregnancy, and menopause
  • Having penile-vaginal sex with a new partner

Yeast infections are different, but some of the initial root causes can be the same. While your vagina naturally contains different types of yeast, the good bacteria we discussed earlier — lactobacilli — typically keep it in check. When something disrupts that delicate balance of bacteria, it can create an overgrowth of one specific type of yeast called candida. Some of the reasons for this overgrowth include:

  • Birth control pills or hormone therapies that increase estrogen levels
  • The use of antibiotics
  • Uncontrolled diabetes
  • Pregnancy
  • An impaired immune system 

It’s important to know that BV and yeast yeast infections aren’t considered sexually transmitted infections (STIs), although they can develop as a result of sexual activity. BV also makes women more susceptible to STIs, including HIV.

The different types of treatment for BV and yeast infections

Because the causes of BV and yeast infections are different, each requires a different plan of attack when it comes to treatment. In general, yeast infections can be treated with over-the-counter (OTC) medications (in some cases, prescription antifungals are necessary). When it comes to BV, prescription antibiotics are the only treatment. 

A few of the most common OTC treatments for yeast infections include suppository creams like miconazole (Monistat) and clotrimazole (Gyne-Lotrimin). If you have a severe infection or you’re experiencing recurrent infections (more than four per year), your doctor may decide to prescribe you a different type of medication. Some medications require just one dose and others require several days or up to two weeks of treatment. It’s best to avoid vaginal intercourse during your treatment and steer clear of inserting anything into your vagina that could harbor bacteria, like tampons, menstrual cups, and sex toys.

BV requires a different type of treatment — usually one of two types of oral antibiotics called metronidazole (Flagyl) and tinidazole (Tindamax). Your doctor may also prescribe a suppository cream like clindamycin (Cleocin). Just like with yeast infections, it’s best to avoid sex, tampons, menstrual cups, and sex toys during treatment.

Tips for preventing BV and yeast infections

While the treatments may differ, the prevention strategies for avoiding BV and yeast infections definitely overlap. The key objective is to maintain the natural bacterial balance of your vagina. Here are some ways to do that:

  • Always wipe from front to back in the bathroom.
  • Don’t douche — just don’t.
  • Talk to your doctor about taking probiotics.
  • Wear cotton underwear that’s not too tight and wicks away moisture.
  • Avoid long hot baths and too much time in hot tubs.
  • Don’t use scented products on your vulva.
  • If you go for a sweaty work out or swim, change out of wet clothes ASAP.

When to see a doctor

While yeast infections can usually be treated with OTC medications, there are some instances that merit a doctor’s office visit. If it’s your first yeast infection ever, it’s best to see your doctor to make sure you’re not actually experiencing another issue that requires different treatment, like a urinary tract infection, or an STI. It’s also a good idea to go to the doctor if you get a yeast infection while pregnant since some not all OTC meds are pregnancy-safe. And finally, if you get yeast infections a lot (four or more a year), it’s worth seeing your doctor and asking about a longer-term treatment.

Without a doctor, it can be tough to know if you have BV or something else. If you’re having vaginal discharge that comes with an odor or goes along with a fever, it’s time to make an appointment. If you have multiple sex partners or you recently started having sex with someone new, it’s also a good reason to see your doctor since the symptoms of BV can sometimes resemble those of STIs. And finally, if you thought you had a yeast infection but the OTC remedies just aren’t working, it’s time to get to the doctor’s office.