Bacterial Vaginosis or Yeast Infection? Here’s How to Tell

Few things can disrupt your day like itching, irritation or unexpected discharge. While uncomfortable, these symptoms are also common. For women, the two most frequent causes are bacterial vaginosis (BV) and yeast infections. While the two conditions may seem similar at first glance, it’s important to understand their differences.

“Bacterial vaginosis and yeast infections are very different conditions, caused by unique imbalances in the vaginal ecosystem,” says Jennifer Velotta, MD, an OB/GYN at University Hospitals. “Knowing which one you’re dealing with is key, because the treatments are different.”

What’s the Difference?

The vagina has a delicate microbiome, made up mostly of Lactobacillus bacteria. These “good” bacteria keep the environment slightly acidic, which helps protect against infection. Infections develop when that healthy balance shifts and other bacteria take over. “Women often notice a change in discharge and odor,” says Dr. Velotta. “With BV, the discharge can be thin and grayish, and heavy in volume. It usually causes a change in odor, especially noticeable after a period or after intercourse.”

While BV can cause irritation, it typically does not cause pain. Yeast infections, on the other hand, can cause pain in addition to itching and burning – particularly after intercourse. A fungal infection caused by an overgrowth of Candida, yeast infections are typically characterized by a thick, cottage cheese-like discharge.

Targeting Treatment to the Right Infection

Because BV and yeast infections have different causes, the treatments are different, too.

For BV, the standard treatment is oral or vaginal antibiotics, while yeast infections are treated with antifungal medications such as oral fluconazole or topical azoles (clotrimazole, miconazole, terconazole).

Different species of yeast may require alternative antifungal prescriptions. So while it’s okay to start with an over-the-counter yeast infection cream, if the infection doesn’t resolve quickly, you should see a doctor. “There are other conditions – like skin issues, contact dermatitis or sexually transmitted infections – that can mimic BV or yeast and should be ruled out,” adds Dr. Velotta.

Recurring infections are another reason to seek care. Both BV and yeast infections can be one-time events – or stubborn, chronic problems. Some women are more vulnerable to shifts in vaginal pH, which makes them more vulnerable to BV. “Semen and menstrual blood both have a higher pH than the vagina,” explains Dr. Velotta. “When that balance is disrupted, BV can flare up again.” In addition to using preventive strategies for recurrent BV, new research suggests that treating male partners can reduce infection recurrence.

Yeast infections are classified as recurrent if they happen three or more times in a year. In those cases, healthcare providers can prescribe antifungal medication on a preventive schedule.

Breaking the Cycle

So how can you keep your vaginal health optimized to prevent infection? Less is often more.

“Keep things simple when it comes to keeping clean,” says Dr. Velotta. That means use gentle, unscented soap and warm water, sticking to lubricants and moisturizers for sensitive skin only – and skip the douching. “Douching washes away the good bacteria you need,” she explains.

Boric acid suppositories or probiotics may sometimes be used alongside antibiotics, especially for recurrent cases. “Adding these elements can help women support their vaginal microbiome by breaking down the opportunistic bacteria that can take root and allowing healthy bacteria to return,” adds Dr. Velotta.

Vaginal Health Is Whole-Body Health

Finally, experts point out that the vaginal microbiome doesn’t exist in isolation. “There’s a strong connection between the gut microbiome and vaginal health,” says Dr. Velotta. “Supporting your body with good nutrition benefits both.” That means a balanced diet, less processed food and less added sugar may help both gut and vaginal health.

If you do notice vaginal irritation, itching or discharge, know you’re not alone. “These conditions are incredibly common,” adds Dr. Velotta. “If you’re unsure what is going on, or if symptoms keep coming back, see a doctor so you can find relief faster.”

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At University Hospitals, OB/GYN physicians provide expert diagnosis and treatment for both common and complex women’s health conditions.