Bacterial Vaginosis vs. Yeast Infections: What’s the Difference?

Highlights from this article 

• BV and yeast infections are vaginal infections that cause symptoms such as abnormal discharge, unpleasant smell, irritation, or pain. 
• BV is caused by the overgrowth of bacteria while yeast infections are caused by the overgrowth of fungus.
• BV discharge is thin, grey, or white and has a distinctive fishy odor, while yeast infection discharge is white with a thick consistency (similar to cottage cheese) and is usually odorless or smells like yeast.
• BV is treated with prescription antibiotics, while yeast infections are treated with an antifungal medication known as “-azoles”.
• Recurrence is common, so prevention is key! 
  

Bacterial vaginosis (BV) and yeast infections are two very common vaginal conditions. Up to 75% of women will have a vaginal yeast infection at least once in their lifetime and one in three people with vaginas will get BV each year.

As you likely know from having one or the other (or both), BV and yeast infections can cause a host of symptoms including pain, itching, and abnormal discharge or smell.  

Not only are they both irritating, frustrating issues, but it can be tricky to tell them apart. Especially given that most sex-ed is subpar, many people with vaginas never learned the difference in the first place! 

Being misdiagnosed actually happens more often than being correctly diagnosed. In a study of 220 symptomatic patients, 61% of BV and 77% of yeast infection diagnoses were incorrect.  We aren’t much better at diagnosing ourselves, either. One study showed self-diagnoses of BV were correct only 56% of the time, while 69% of those who thought they had a yeast infection actually had something else. Another article showed that only about a third of individuals were correct in diagnosing themselves with a yeast infection.

However, the causes, symptoms, and treatments for BV and yeast infections have some telltale differences. Keep reading to learn more about the key differences between BV and yeast infections, and tips to prevent both.

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Causes of BV and yeast infections

BV and yeast infections are both caused by an overgrowth of microbes in your vaginal microbiome, leading to vaginitis — but the main difference between BV and yeast infections is what kind of microbe is responsible for the infection.

BV is an umbrella term for an infection caused by disruptive bacteria, while a yeast infection is caused by various types of Candida, which are fungi. 

Possible triggers for BV

In a healthy vaginal microbiome, protective bacteria — namely, lactobacilli — stop disruptive bacteria from taking over. However, sometimes they fall short. When this happens, it can lead to BV. Some possible triggers for BV are:

• Sex 
• Hormonal fluctuations (e.g. birth control, pregnancy, and menopause)
• Your period
• Smoking

• Stress
• Douching/using vaginal products 

Possible triggers for yeast infections

When it comes to yeast, most people already have a small amount in their bodies (including the vagina) without it causing any issues. However, when levels of yeast increase beyond a healthy amount, it can lead to a yeast infection. Possible triggers for yeast infections include: 

• Antibiotics  
• Sex 
• Birth control method, specifically oral contraception and IUDs 
• Hormonal changes, such as pregnancy or utilizing hormone replacement therapy
• A weakened immune system
• Diabetes

Do I have a yeast infection or BV? 

BV and yeast infections sometimes present very differently. For example, a strong fishy smell is exclusively a BV symptom, while white, clumpy discharge is the hallmark symptom of a yeast infection. 

However, both conditions can produce symptoms that are a bit ambiguous — BV may be asymptomatic and yeast infections may be more irritating than they are visually apparent. 

Here are the full lists of symptoms to help distinguish between the two: 

BV symptoms  

Common symptoms of BV include:

• White or grey vaginal discharge that is thin and watery
• A strong or fishy odor (that becomes stronger after sex).  
• In some cases, BV can also cause pain, discomfort, or burning during sex and when peeing. 
  

That said, BV can often occur without any symptoms at all. Up to 84% of those with BV are asymptomatic. While some may feel blessed to do without the unwanted discharge, this is concerning because BV can increase the risk of other health issues, such as:

• STIs like chlamydia, gonorrhea, trichomoniasis, herpes, HPV, and HIV 
• Pelvic inflammatory disease (PID)
• Fertility issues and failed IVF
• Pregnancy complications like miscarriage, preterm birth, neonatal problems, and preeclampsia 
• Gynecological cancers such as ovarian, cervical, or endometrial cancer
• Cervicitis
• Toxic shock syndrome (TSS)

Yeast infection symptoms 

Common symptoms of a yeast infection are:

• Lumpy, white, cottage cheese-like discharge 
• Itching or burning around the vulva and vagina
• Pain or discomfort during sex and when peeing 
  

If you’re not totally sure whether you have BV or a yeast infection, it’s best to check in with your OB-GYN or general healthcare provider. Your provider may perform a pelvic exam to obtain a sample by swabbing the vaginal wall and discharge to help make the diagnosis. 

It is important to note that both of these infections also share symptoms with STIs like trichomoniasis and chlamydia. As STIs can lead to long-term consequences, it is best to check with a doctor ASAP if this could also be a possibility.

Treatment for BV and yeast infections

Since yeast infections and BV are caused by different microbes, they’re treated by different types of medication. 

BV is treated with prescription antibiotics (metronidazole, clindamycin, tinidazole, etc.) that can either be taken orally or vaginally. 

Yeast infections are treated with prescription or over-the-counter (OTC) antifungal medications called azole antifungals — like clotrimazole, miconazole (Monistat), and terconazole — which also can be either oral or vaginal treatments. 

Both BV and yeast infections have an annoying habit of resisting treatment or coming back — just our luck. Researchers are still trying to find effective, long-term treatment options for recurrent vaginal infections so prevention is key. 

How to prevent BV and yeast infections from coming back

One way to help prevent a BV recurrence is to take a probiotic with helpful strains of vaginal bacteria regularly. Vaginal probiotics have also shown some promise when it comes to yeast infections as well. 

But not all probiotics are created equal — many don’t even contain strains of bacteria naturally found in the vagina! While the concept is promising (replenishing the protective bacteria in your microbiome) the type of probiotic used must be specifically designed for vaginal health and scientifically proven to work.

Boric acid is another common vaginal treatment. Despite how widely used it is, research on boric acid is still emerging. It is recommended by the CDC for yeast infections caused by Candida glabrata, but there is not strong research showing its effectiveness against BV. It *may* help to break down biofilm formed by BV-causing bacteria, as well as increase acidity and make the vagina inhospitable to pathogens. However, more research is needed! 

Above all, avoiding things that can disrupt your vaginal microbiome or irritate your vagina is the best way to keep your vagina healthy. To reduce your chances of getting BV or yeast infections, try to maintain healthy habits such as: 

• Practicing safe sex (use condoms and dental dams, wash your toys, etc.)
• Avoiding douching and using feminine hygiene washes
• Wipe front to back
• Change your period products within the proper time frame
• Stick to underwear that is loose-fitting, lightweight, breathable, and made from a natural fabric, and change it often
• Wash sex toys with every use

Get care for BV and yeast infections with Evvy

If you notice that you’re experiencing recurrent episodes of bacterial vaginosis, yeast infections, or vaginal symptoms, it might be helpful to test with Evvy over time to see if any specific behaviors are triggering. 

We've created the first-ever platform for vaginal healthcare that combines state-of-the-art vaginal microbiome testing, prescription treatment, and 1:1 coaching to get you the answers, relief, and support that you deserve. Built with leading OB-GYNs and researchers, Evvy's care platform can connect you to providers trained to review your vaginal microbiome results and select the best care for bacterial vaginosis, yeast infections, and other vaginal symptoms. They'll also recommend research-backed supplements to build back your microbiome to a protective state!