UTI vs BV: How to Tell the Difference and Get the Right Treatment

Two of the most common causes of burning and discomfort in people with vaginas are urinary tract infections (UTIs) and bacterial vaginosis (BV). They’re both incredibly common, they can feel confusingly similar, and they’re sometimes mistaken for each other. That mix‑up can delay the right treatment and keep symptoms lingering longer than they need to.

Keep reading to learn the key differences between UTIs and BV, their causes, how symptoms overlap (or don’t), and how to treat both infections.

What are urinary tract infections (UTIs) and bacterial vaginosis (BV)?

A UTI is an infection anywhere along the urinary tract. That includes the urethra (the tube that carries urine out of the body), the bladder, and sometimes the kidneys. Most UTIs are bladder infections, which is why they’re often associated with painful or frequent urination. UTIs happen when bacteria (most commonly E. coli from the gut) make their way into the urinary tract and start multiplying where they don’t belong.

Bacterial vaginosis is something entirely different, even though the symptoms can sometimes feel related. BV isn’t an infection of the urinary tract at all, but rather an imbalance in the vaginal microbiome. A healthy vagina is usually dominated by healthy bacteria called Lactobacillus, which help keep the vaginal environment slightly acidic. With BV, those protective bacteria decrease and are replaced by an overgrowth of other bacteria, like Gardnerella vaginalis and other anaerobes (bacteria that don’t need oxygen to survive).

Both urinary tract infections and bacterial vaginosis are common in people with vaginas because of anatomy and biology. The urethra is short and close to the vagina and anus, which makes it easier for bacteria to travel. Meanwhile, the vaginal microbiome is sensitive to changes in hormones, sex, hygiene habits, and even stress. They’re different systems with different causes — but there’s a lot of overlap in how these two conditions show up.

What causes UTIs vs BV?

Bacterial vaginosis (BV) is caused by an overgrowth of bacteria that normally live in the vagina, while urinary tract infections (UTIs) occur when bacteria enter the urinary tract.

UTIs are usually caused by bacteria entering the urinary tract and sticking around long enough to cause inflammation. E. coli is responsible for the majority of UTIs, but other uropathogens can be involved, too. Many factors can increase your risk for a UTI:

• Sex can introduce bacteria into the urethra
• Dehydration can make it harder to flush bacteria out
• Holding your urine for long periods gives microbes more time to grow
• Some people are also more prone to UTIs because of genetics, pelvic anatomy, or changes in estrogen levels.

Bacterial vaginosis develops when protective Lactobacillus levels drop, and other bacteria take over. This shift can be triggered by several factors, including:

• Your period
• Sexual intercourse (especially with new or multiple sexual partners)
• Douching or using scented vaginal products
• Smoking
• Chronic stress
• Hormonal shifts, such as those that happen during pregnancy, postpartum, or perimenopause. 

Importantly, bacterial vaginosis hasn’t traditionally been classified as a sexually transmitted infection, but that understanding is evolving. More and more experts now recognize that BV can be sexually transmitted, since one partner can pass BV-associated bacteria to their female partner during unprotected sex. Sexual activity can significantly influence the vaginal microbiome, increasing the risk of developing or recurring BV.

Where UTIs and BV occur in the body

One of the clearest ways to tell urinary tract infections and bacterial vaginosis apart is where they happen. UTIs occur in the urinary tract, most often in the bladder or urethra. That’s why symptoms tend to involve a burning sensation when you pee, urgency, or feeling like you need to pee constantly.

BV happens in the vaginal tract. It’s a vaginal microbiome imbalance, not a urinary one. Symptoms like unusual discharge or a strong fishy odor usually point toward the vagina rather than the bladder. While the proximity of these areas can make symptoms feel connected, pain with urination usually suggests irritation of the urethra or bladder, whereas changes in discharge or odor almost always originate in the vagina.

Common symptoms: How do you know if it’s a UTI or BV?

This is where things get tricky. Some symptoms are very distinct, while others overlap just enough to confuse. Urinary tract infections are famous for causing burning when you pee, frequent urges to urinate, and pelvic pressure. BV is better known for vaginal odor and abnormal vaginal discharge. But bodies don’t always follow the rulebook.

For example, bacterial vaginosis can sometimes cause irritation around the vaginal opening, which can make urination feel uncomfortable and cause a similar burning sensation to a UTI. And urinary tract infections can occasionally cause cloudy pee or a strong smell that people mistake for vaginal odor. To make things even more confusing, it’s possible to have both at the same time.

Paying attention to where symptoms are coming from and what they feel like can help narrow things down. Are you experiencing changes in discharge or odor that aren’t tied to peeing? That leans BV. Is the discomfort tightly linked to urination itself, with little change in vaginal discharge? That leans UTI. Still, symptoms alone can’t always give a definitive answer, which is why testing matters.

Typical UTI symptoms

Urinary tract infections tend to announce themselves pretty loudly. Common symptoms include:

• A burning or stinging sensation when you pee
• A frequent or urgent need to pee, even when little comes out
• Feeling like your bladder never fully empties
• Cloudy or dark urine
• Strong‑smelling urine
• Pelvic pressure or discomfort
• Lower abdominal pain.

Typical BV symptoms

BV symptoms are more focused on vaginal changes. Common signs include:

• Thin, gray, or white vaginal discharge
• A strong fishy odor that gets worse after sex
• Vaginal itching or irritation
• Burning or discomfort around the vaginal opening. 

Most people who have BV will never experience any symptoms, but for those who do, BV can cause discomfort and stress.

How UTIs and BV are diagnosed

Because symptoms can overlap, diagnosis is really about identifying what’s happening at the microbial level. In a clinic, UTIs are usually diagnosed with a urine sample. Providers may use a dipstick test, microscopy, or send the sample for culture. These methods can confirm whether bacteria are present in the urine, but they don’t always identify every possible pathogen or explain why infections keep coming back.

BV is typically diagnosed with a vaginal swab. In‑office tests may look at vaginal pH, clue cells under a microscope, or use molecular testing. Like UTIs, BV can be under‑ or misdiagnosed, especially if symptoms are mild or atypical.

At‑home testing has made it easier to get clear answers without waiting weeks for appointments. Evvy’s Vaginal Health & UTI+ Test is designed for people who want a comprehensive view of what’s happening in both the urinary tract and the vagina, especially if symptoms are recurrent or confusing. Combining advanced testing for UTIs and vaginal infections in one bundle helps uncover the pathogen responsible for the infection, rather than just treating symptoms. 

Testing for UTIs

Testing for UTIs has traditionally relied on standard urine cultures, but these tests have real limitations. They can take several days to return results and may fail to detect up to 50–70% of UTI‑causing pathogens, especially slow‑growing or less common bacteria and fungi. 

Evvy’s UTI+ Test is an at‑home urine test that uses PCR technology to detect UTI‑causing bacteria and fungi with much higher sensitivity. It also identifies antibiotic resistance genes, which can be especially helpful for people with recurrent or hard‑to‑treat UTIs.

Instead of guessing which antibiotic might work, PCR testing shows exactly which microbes are present and which treatments they may resist. This matters because nearly one in two women are prescribed an antibiotic that may not actually work against their infection, and three in four receive courses that are longer than necessary. Having precise results from the start can help you and your provider choose the right treatment the first time, reducing trial‑and‑error, unnecessary antibiotics, and repeat infections.

Testing for BV and other vaginal infections

In a clinical setting, bacterial vaginosis is usually diagnosed using a vaginal swab. Providers may assess vaginal pH, look for “clue cells” under a microscope, or run molecular tests that detect BV-associated bacteria. While these methods can be helpful, they often underdiagnose BV, provide a limited snapshot, and don’t explain why BV keeps coming back for some people.

BV diagnosis is most accurate when you can see the full vaginal microbiome. Evvy’s Vaginal Health Test uses metagenomic sequencing to analyze the bacteria and fungi in the vagina at a species level. Rather than just saying “BV positive” or “negative,” it shows how much protective Lactobacillus you have, which harmful bacteria are present, and how your microbiome compares to what’s considered optimal.

This level of detail is especially valuable for people with recurrent BV, persistent symptoms, or mixed infections. Understanding your unique microbiome makes it easier to choose treatments and long-term prevention strategies that actually work for your microbiome.

How to treat BV and UTIs: Antibiotics & more

Antibiotics are recommended as the first line of treatment for both BV and UTIs, but because urinary tract infections and bacterial vaginosis have different underlying causes, they also require different treatments. While some antibiotics are broad-spectrum and can act on multiple types of bacteria, antibiotics are most effective when they’re used to target a specific pathogen. 

UTIs are treated by addressing the bacteria in the urinary tract, whereas BV treatment focuses on reducing BV-associated bacteria and restoring balance in the vaginal microbiome. Using the wrong treatment — or a treatment that isn’t well matched to the bacteria involved — can leave symptoms unresolved and increase the risk of recurrence. 

A common question is whether antibiotics for a UTI can clear up BV. The short answer is: sometimes symptoms may temporarily change, but UTI antibiotics aren’t a reliable or appropriate treatment for BV. Without knowing which specific bacteria are causing an infection, treatment can become guesswork. In some cases, UTI antibiotics may even make BV more likely by further disrupting protective vaginal bacteria.

Standard treatment for UTIs

Antibiotics are usually the go-to treatment for urinary tract infections, and doctors will often choose the right one based on the bacteria involved. For uncomplicated UTIs, a short course of antibiotics usually does the trick. However, if someone experiences recurrent or stubborn UTIs, treatment might need to be a bit more specific, sometimes based on PCR test results.

Alongside antibiotics, staying well-hydrated and urinating regularly can really help. It’s also important to address any factors that might contribute to the problem, like low estrogen levels or frequent intercourse. Some folks might benefit from preventive strategies, such as making certain lifestyle changes, using vaginal estrogen, or taking targeted supplements, depending on their needs. 

Standard treatment for BV

BV is typically treated with antibiotics like metronidazole or clindamycin, taken orally or vaginally. These medications work by reducing the overgrowth of BV-associated bacteria, but they don’t replenish protective Lactobacillus on their own. That’s one reason BV has such a high recurrence rate; treatment may clear symptoms without fully restoring a healthy vaginal microbiome.

For some people, adjunct treatments can be helpful alongside or after antibiotics. Boric acid, for example, may help rebalance vaginal pH and reduce the risk of recurrent BV, particularly in persistent or hard-to-treat cases. Probiotics can also support the microbiome by replenishing beneficial bacteria. Options like Evvy’s Boric Acid Suppositories and Vaginal Probiotic Suppositories are designed to support vaginal microbiome health and help maintain a more resilient balance over time. When guided by microbiome testing, these follow-up strategies can be tailored to your body’s specific needs, making long-term relief more achievable than antibiotics alone.

When to talk to your healthcare provider about UTI vs BV

Anytime symptoms are severe, persistent, or unusual, it’s worth talking to a provider. You should seek care promptly if you have fever, back pain, nausea, or vomiting, which can be a sign of a kidney infection — a much more serious type of UTI. Recurrent symptoms, whether urinary or vaginal, are also a good reason to dig deeper rather than repeating the same treatment over and over.

Left untreated, BV can also lead to complications over time. Persistent vaginal imbalances have been linked to an increased risk of pelvic inflammatory disease (PID), complications during pregnancy, and greater susceptibility to sexually transmitted infections. Addressing BV early and accurately can help protect not just vaginal health, but overall reproductive health as well.

If you’re unsure whether symptoms are coming from the urinary tract or the vagina, testing with Evvy can provide clarity and peace of mind. Bringing detailed test results to your provider can lead to more productive conversations and better outcomes.

FAQs about BV vs UTIs

How do you know if it’s a UTI or BV?

The biggest clue is where your symptoms are centered. BV is characterized by thin, fishy-smelling vaginal discharge, while UTIs are associated with burning, frequency, and pain during urination. That said, symptoms don’t always follow the rules. Some people have mild or atypical symptoms, and others may have both conditions at once. Because of this overlap, testing is the most reliable way to know what you’re dealing with and avoid treating the wrong condition.

Can UTI antibiotics clear up BV?

In most cases, no. Antibiotics prescribed for UTIs are chosen to target bacteria in the urinary tract, not the bacteria involved in BV. While you might notice temporary symptom changes, UTI antibiotics don’t reliably treat BV and can sometimes make it worse by further disrupting the vaginal microbiome. BV typically requires specific antibiotics that are effective against anaerobic vaginal bacteria. Treating BV correctly also often involves thinking beyond antibiotics, especially for people who experience frequent recurrences.

What does BV vs UTI pee look like?

With a UTI, urine may look cloudy, darker than usual, or slightly bloody, and it often has a strong or unpleasant smell. These changes come from bacteria and inflammation in the urinary tract. BV doesn’t usually affect urine appearance because it’s a vaginal condition. Instead, BV changes vaginal discharge, which may be thin, gray, or white and accompanied by a noticeable odor. Sometimes discharge can mix with urine in the toilet, which is why it can feel confusing.

Can BV cause urinary symptoms that feel like a UTI?

In a way, yes. BV can cause irritation and inflammation around the vaginal opening and urethra, which may lead to burning or discomfort during urination even when there’s no true urinary tract infection present. This is one reason BV is sometimes mistaken for a UTI and treated incorrectly. If urinary symptoms keep coming back despite negative urine tests or UTI treatment, it’s worth considering whether a vaginal imbalance like BV could be playing a role.

What tests do doctors use to diagnose BV versus UTI?

Doctors typically diagnose UTIs using urine tests, such as dipsticks, microscopy, or urine cultures, to look for bacteria and signs of infection. For BV, providers usually rely on vaginal swabs to assess pH, look for clue cells, or run molecular tests that detect BV-associated bacteria. Advanced at-home tests can offer more detailed information by identifying specific microbes and imbalances in both the urinary tract and the vagina. This deeper insight can be especially helpful for people with recurrent symptoms or unclear diagnoses.