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

Itching, burning, or unusual discharge can come from several causes, and two of the most common are bacterial vaginosis (BV) and a yeast infection. They can feel alike, but they are different problems with different treatments. Using the wrong medicine can delay relief.

This article explains how the two differ, why a proper diagnosis matters, how each one is treated, and how to lower your risk. For what is normal discharge, see What’s Normal Vaginal Discharge?.

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Quick Answer

BV is caused by a change in the balance of bacteria in the vagina, and its discharge is often white or gray with a fish-like smell (1). A yeast infection is caused by an overgrowth of a fungus, and it typically causes extreme itching and a thick white discharge without a bad smell (2). BV needs prescription antibiotics, and over-the-counter yeast medicine will not treat it (1).

How They Differ

Bacterial Vaginosis

The Office on Women’s Health says BV is the most common vaginal condition in women ages 15 to 44. It happens when harmful bacteria outnumber the helpful ones (1). Many women have no symptoms at all. When symptoms appear, the discharge may be white (milky) or gray, and some women notice a strong fish-like smell, especially after sex (1).

Risk goes up with a new sex partner or several partners, and with douching. BV is not counted as a sexually transmitted infection, but untreated BV can raise your risk of getting one, including HIV (1).

Yeast Infection

Most women will get a vaginal yeast infection at some point in life. It is caused by an overgrowth of a fungus called Candida, which is normally present in small amounts (2). The main symptom is extreme itching in and around the vagina. Other signs include burning, redness, swelling, and pain when urinating or during sex (2).

Risk is higher during pregnancy, with poorly controlled diabetes, after some antibiotics or steroids, with douching or vaginal sprays, and with a weakened immune system (2). A yeast infection is not an STI.

Side by Side

These are the typical differences, but they are not a reliable way to diagnose yourself:

• Smell. BV often has a fish-like smell. A yeast infection usually has no bad smell.
• Discharge. BV discharge is white (milky) or gray. Yeast discharge is thick, white, and looks like cottage cheese.
• Itching. Extreme itching is the main symptom of a yeast infection.
• Treatment. BV needs prescription antibiotics. A yeast infection can be treated with over-the-counter antifungal medicine or a prescription.

The Office on Women’s Health stresses that seeing a doctor or nurse is the only way to know for sure, because the symptoms also resemble those of some STIs (2). Burning when you urinate can also point to a urinary tract infection. See UTIs: Causes, Symptoms, and Prevention for the signs.

How They Are Diagnosed

For both conditions, your doctor or nurse takes a sample of vaginal discharge. It may be checked under a microscope, tested in the office, or sent to a lab (1) (2). For a yeast infection, a pelvic exam is also done to look for swelling and discharge (2).

Treatment

BV is treated with antibiotics prescribed by your doctor. Take the whole course, even if the symptoms go away (1). You cannot treat BV with over-the-counter yeast infection medicine (1). BV can come back even after treatment (3), so tell your doctor if symptoms return.

A yeast infection can be treated with over-the-counter antifungal creams, tablets, or suppositories, used for up to seven days. A doctor can also prescribe a single pill, such as fluconazole (2). Fluconazole by mouth should not be used in pregnancy because it may cause birth defects, but creams or suppositories with miconazole or clotrimazole are considered safe (2).

Probiotics, such as yogurt with live cultures or capsules with Lactobacillus, are sometimes used to restore the balance of vaginal bacteria. A 2014 review of trials on BV found mixed results, but most favored probiotics for preventing or treating it, and no side effects were reported (4).

For yeast infections, the Office on Women’s Health says studies suggest probiotics may help prevent infection, but more research is needed to say for sure (2). Probiotics do not replace the treatment your doctor prescribes.

Pregnancy and Partners

Untreated BV in pregnancy can lead to premature birth or a low-birth-weight baby, and treatment is safe at any stage of pregnancy (1). A male partner generally does not need treatment for BV. If your partner is a woman, she might also have BV and should see her doctor (1).

How to Lower Your Risk

These habits help with both conditions (1) (2):

• Do not douche, and avoid scented feminine products and vaginal sprays.
• After using the toilet, wipe from front to back.
• Clean the outside of the vagina with warm water only.
• Change tampons, pads, and liners often.
• Wear cotton-crotch underwear and avoid tight clothing.
• Change out of wet swimwear and workout clothes soon.
• Use condoms, and keep blood sugar well controlled if you have diabetes.

When to See a Doctor

Consider speaking with a healthcare professional if:

• You have unusual discharge, itching, or odor and this is your first time.
• You are not sure whether it is BV, a yeast infection, or an STI.
• You treated a yeast infection yourself and the symptoms did not go away.
• You have four or more yeast infections in a year.
• You are pregnant and have any of these symptoms.
• BV comes back after treatment.

Get checked before you treat yourself. The Office on Women’s Health points out that the right treatment depends on the right diagnosis (2). For other reasons to book a visit, see When to See a Gynecologist.

Conclusion

BV and yeast infections can look alike, but they need different treatment. BV is a change in vaginal bacteria with a fish-like smell and needs prescription antibiotics. A yeast infection causes intense itching and a thick white discharge without a bad smell, and over-the-counter antifungal medicine usually helps.

Because treating the wrong one delays relief, see a doctor or nurse the first time and any time the symptoms come back. Avoiding douching and scented products, and wiping from front to back, can lower your risk.

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Sources

1. Office on Women’s Health (U.S. Department of Health and Human Services). Bacterial Vaginosis.
2. Office on Women’s Health (U.S. Department of Health and Human Services). Vaginal Yeast Infections.
3. Centers for Disease Control and Prevention (CDC). About Bacterial Vaginosis.
4. Homayouni A, Bastani P, Ziyadi S, et al. Effects of Probiotics on the Recurrence of Bacterial Vaginosis: A Review. Journal of Lower Genital Tract Disease. 2014;18(1):79-86.