BV or Yeast Infection? How to Tell the Difference

Changes in discharge, smell or itching are a reason to see a clinician. BV is the most common cause of vaginal discharge worldwide, and yeast infections are also common. They are easy to mix up, so here is how they usually differ and why guessing can backfire.

Is it BV or a yeast infection?

Here is the usual pattern. Real life is messier, and many people don’t match it neatly.

• BV (bacterial vaginosis): thin, milky discharge with a fishy smell. A fishy smell is a key sign of BV.
• Yeast infection: thick, white, curdy discharge, with itching, burning and redness of the vulva and vagina. Burning when you pee can also happen, because urine touches irritated skin.

A fishy smell points toward BV. Intense itching is typical of yeast.

How can I tell if I have a yeast infection?

Typical symptoms include itching, soreness, pain during sex, burning when you pee and abnormal discharge. None of these is specific to yeast, so a clinician’s exam matters. The skin around the vulva may look swollen or have small cracks.

Yeast infections are usually caused by Candida albicans, a type of yeast.

Can I just assume it’s yeast if I have discharge?

It is easy to assume, but the symptoms overlap, so guessing can go wrong. Unnecessary use of over-the-counter treatments can delay treatment of other causes, such as BV, and the real problem carries on.

Over-the-counter yeast treatments are available. If your symptoms persist after using one, or come back within two months of treatment, see a clinician.

Is BV an STD?

BV’s cause is not fully understood, and it is not known whether it comes from a single sexually transmitted germ. In BV, the normal lactobacilli in the vagina are replaced by high levels of other bacteria. It is linked to sexual activity, and it is more common with a new partner or several partners. Douching is also linked to it. People who have never been sexually active are rarely affected.

What else can cause the same symptoms?

Several STIs can cause discharge that looks like BV or yeast:

• Trichomoniasis can cause discharge that is yellow-green and can smell bad, with or without irritation of the vulva. Most people with it have minimal or no symptoms.
• Chlamydia often has no symptoms. When it does cause symptoms, they can include unusual discharge.

Because they overlap, it is worth ordering an STD test online if you could have been exposed. See our page on yellow or green discharge for more.

How are BV and yeast diagnosed?

A clinician will ask about your symptoms and sexual history, and may do a pelvic exam. They take a small sample of discharge with a swab and check it under a microscope, test its pH, or send it to a lab. This helps tell BV, yeast and trichomoniasis apart. STD tests for chlamydia and gonorrhea use a swab or urine sample. Self-collected vaginal swabs can also be used for BV testing.

BV and yeast need an exam and swab from a doctor or clinician. For the STD side, you can order an online STD test, and which STD test do I need explains what to choose.

What can make BV or yeast more likely?

Some things are linked to a higher chance of each one:

• For BV: douching, and a new or more than one sexual partner.
• For yeast: frequent antibiotic use, pregnancy, poorly controlled diabetes and conditions that weaken the immune system.

CDC notes that no data support douching for treatment or symptom relief, so stopping it is a good idea. It won’t clear an infection that is already there, so see a clinician if symptoms last.

How are they treated?

In general terms: yeast infections are treated with antifungal medicine, and BV is treated with antibiotics prescribed by a clinician. They are different treatments, so knowing which one you have matters. Both can come back, so tell your clinician if symptoms return.

If you are pregnant, tell the clinician before starting any treatment.