What is BV?

Bacterial vaginosis is a vaginal infection caused by the overgrowth of disruptive bacteria in your vaginal microbiome — most commonly, Gardnerella and Prevotella

BV is the most common vaginal condition in women ages 15-44, and almost 30% of people with vaginas get BV each year, according to the Centers for Disease Control (CDC).

BV occurs when the harmful bacteria in your vaginal microbiome grow faster than the protective bacteria (lactobacilli), resulting in an imbalance of naturally occurring bacteria called dysbiosis. 

Research shows that certain activities or events can increase your risk of BV, including: 

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Is BV an STD?

No, BV isn't a sexually transmitted disease (STD), and anyone with a vagina can get BV (even if they’re not sexually active), but certain aspects of sex can trigger BV. Having unprotected sex and having multiple sex partners are risk factors for BV.

Although it’s not a sexually transmitted infection, having BV can increase your risk of contracting an STD. 

How to know if you have BV

There are two diagnostic methods to know if you have bacterial vaginosis — by looking at your symptoms or with a swab test. 

The symptomatic diagnosis uses the Amstel criteria, which requires you to have three out of four symptoms, which your medical provider will evaluate for: 

  • thin, gray/white discharge
  • clue cells
  • a vaginal pH over 4.5
  • a fishy odor. 

The safest bet is to see your healthcare provider rather than self-diagnosing. Research shows that most of us aren't very good at self-diagnosing BV. One study showed that only 56% of self-diagnoses of BV were correct. It’s also worth remembering that BV doesn’t always cause symptoms, so you can’t rely on those alone. 

The second way to diagnose bacterial vaginosis is by using the Nugent score diagnosis, which involves examining a vaginal smear under a microscope and counting three bacteria morphotypes — Lactobacillus, Gardnerella, and curved gram rods. A score under 4 is healthy, 4-7 is intermediate, and 7-10 is BV. 

Whether or not you're dealing with symptoms, Evvy's at-home vaginal microbiome test screens for any infection-causing fungi and bacteria, including ones linked to BV.  

What is trichomoniasis?

Trichomoniasis, or “trich,” is one of the most common non-viral sexually transmitted infections in the US. Anyone sexually active can get it, but women have an increased risk of contracting trich because the parasite that causes it tends to thrive in moist environments like the urethra, vagina, and vulva. 

What causes trichomoniasis?

Trichomoniasis is caused by a parasite called Trichomonas vaginalis (TV). It's spread through unprotected sexual contact and bodily fluids such as semen and vaginal fluid. 

Bacterial vaginosis vs trichomoniasis symptoms

Although they’re very different infections, BV and trichomoniasis share a lot of similar symptoms — the most common symptom being foul-smelling discharge. 

BV symptoms 

The most common signs and symptoms of BV are: 

  • a strong, unpleasant, or fishy vaginal odor that gets worse after sex
  • abnormal vaginal discharge that is thin and watery and is usually white or gray
  • In some cases, pain, itching, or a burning sensation in the vagina.

Bear in mind that bacterial vaginosis can be asymptomatic, and up to 84% of people with BV may not experience anything at all. 

Trichomoniasis symptoms 

Some common trich symptoms include: 

  • Genital itching and irritation
  • Abnormal vaginal discharge that is thin and frothy and is green or grey
  • A foul or fishy odor 
  • Painful urination
  • The frequent need to pee
  • Spotting or bleeding between periods
  • Pain during sexual intercourse.

Similarly to BV, trichomoniasis can often be asymptomatic. Around 70% of people with trichomoniasis don't experience any symptoms at all, according to the CDC.

How to treat trichomoniasis

Trichomoniasis is easily treatable with oral antibiotics. There are two common medications available: metronidazole and tinidazole. Metronidazole is usually given in a single dose, while tinidazole is taken in a lower dose twice a day for seven days.

One thing to keep in mind is that you should avoid alcohol during treatment. Also, you and your partner must receive treatment, even if your partner has no symptoms. People with penises don't usually experience symptoms, but they can still be infected and spread trich to others. So, getting treated as soon as possible is best to avoid spreading trichomoniasis to other partners.

BV treatment

Prescription antibiotics (metronidazole, clindamycin, tinidazole, etc.) are the first-line treatment for bacterial vaginosis. They can either be taken orally or vaginally, depending on how bad your symptoms are. 

Annoyingly, bacterial vaginosis has a nasty habit of returning even after treatment. While antibiotics clear up to 85% of BV cases within a month, over half of people experience a relapse within six months. Some studies have even shown recurrence rates as high as 80% even after what was considered "effective treatment" for three months.

Over-the-counter BV treatment

It can be extremely frustrating to have to take antibiotics repeatedly to treat BV. Unfortunately, no FDA-approved over-the-counter medicines for bacterial vaginosis are currently available. 

Some research shows that boric acid vaginal suppositories might be a promising alternative, but we need more data to know for sure. In one study, a dual treatment for BV using boric acid and antibiotics kept 87% of patients symptom-free for 12 weeks after diagnosis. The positive results didn't last for everyone, though, and the patients still needed antibiotics in the first place. It's also important to note that healthcare professionals don't recommend using boric acid to treat BV. 

Similarly, emerging research found that probiotic supplements could help prevent recurrent BV, but there still needs to be more evidence. 

When it comes to vaginal infections, treatment should be personalized to your unique health history and vaginal microbiome, so it's really important to speak with your healthcare provider about potential over-the-counter solutions for BV. ‍In the meantime, the Evvy vaginal microbiome test can help provide insights based on your microbiome to share with your medical provider.


How can you tell the difference between BV and trichomoniasis?

The only real way to tell the difference between BV and trichomoniasis is to do an STI test. BV and trich share a lot of symptoms, so it can be tricky to tell them apart. The main difference between BV and trichomoniasis is that BV occurs when there's an imbalance of normal bacteria in your vaginal microbiome, whereas trichomoniasis is an STI caused by a tiny parasite that spreads through oral, vaginal, and anal sex. It's important to note that while trichomoniasis is an STI, BV isn't. However, sex is considered a trigger for BV. 

Can they mistake BV for trich?

It’s very easy to mistake BV and trichomoniasis because they cause very similar symptoms. Being misdiagnosed actually happens more often than being correctly diagnosed. In a study of 220 symptomatic patients, 61% of BV diagnoses were incorrect. The best way to know whether you have BV or trichomoniasis is to see your healthcare provider or take Evvy’s at-home vaginal health test, which screens for both BV and trichomoniasis (and other sexually transmitted diseases).

Does trich or BV smell?

Both trichomoniasis and BV can cause unusual discharge with a strong or fishy smell. It’s normal for your vaginal discharge to have a mild smell (it comes out of your vagina, after all), but any drastic change in odor — especially if it’s foul or fishy — can be a warning sign for BV or trich, and warrants a trip to the OBGYN.