Tia Tackles: The Differences and Similarities Between BV and Yeast Infections

Mae West once said: “Too much of a good thing can be wonderful.” She also said: “Too much of a good thing can be taxing.” So, which is it? Well, when it comes to vaginal discharge, the truth lies somewhere in the middle. For the most part, vaginal discharge is a wonderful thing; a normal and healthy process that keeps the vagina clean and lubricated. It protects the vagina and vulva (the external genitals surrounding the vaginal opening) against infection and irritation.

What is normal vaginal discharge? In premenopausal women and people assigned female at birth (AFAB), it is normal to have approximately one half to one teaspoon of white or clear, watery or thick, mucus-like, often sticky, and mostly odorless discharge every day. However, changes in discharge color, texture, smell, and amount or discharge that occurs with itching or burning can be a sign of infection or disease.

Bacterial vaginosis (BV) and yeast infections are two common types of vaginal infections that can be difficult to distinguish from one another because both conditions have similar symptoms – like changes in vaginal discharge, itching, burning, and pain. However, even if both infections have overlapping presentations, BV and yeast infections have different causes, treatments, and preventive measures. And because 35% of women and AFAB will experience an episode of BV and 75% of them will get a yeast infection in their lifetimes, it is worth taking a deeper dive.

What's the difference between bacterial vaginosis and yeast infections?

Bacterial vaginosis is an infection caused by an overgrowth of normal bacteria present in the vagina. However, certain factors might decrease the amounts of helpful bacteria, like Lactobacillus, which raises the pH of the vagina and creates an environment in which harmful bacteria can grow unchecked.

Symptoms of bacterial vaginosis include:

• Thin, grayish-white vaginal discharge with a fishy odor, especially after sex
• A burning sensation when urinating
• Vaginal itching or irritation

On the other hand, yeast infections are not caused by bacteria but by an overgrowth in fungus, usually Candida albicans. Although Candida can be present in the vagina without impact, certain conditions can lead to its overgrowth as well.

Symptoms of yeast infections include:

• Thick, white, odor-free vaginal discharge that resembles cottage cheese. However, thin, watery discharge is also common.
• An itching and burning sensation, especially when urinating or having sex
• Redness and swelling of the vulva

Why do vaginal infections like BV and yeast infections occur?

While the exact cause(s) of BV and yeast infections are not well understood, certain activities and conditions can disrupt the natural balance of microorganisms in the vagina and lead to either infection.

Anyone with a vagina can develop BV, especially if she has a natural lack of

Risk factors for BV:

• Having sex with a new partner
• Having sex with multiple partners
• Not using barrier contraception during sex, like a condom
• Being pregnant
• Vaginal douching
• Natural lack of Lactobacillus acidophilus

An important side note: Even though BV is not a sexually transmitted infection (STI), after being diagnosed with BV, women have an increased risk of acquiring an STI.

The fungus

Risk factors for yeast infections:

• Taking oral contraceptives or hormone therapy that increases estrogen levels
• Antibiotic use, which causes an imbalance in natural vaginal flora
• Being pregnant
• Uncontrolled diabetes
• A weakened immune system due to certain medications or an underlying illness
• Obesity

Treatments for Yeast Infections vs. Bacterial Vaginosis

Since most women will experience BV and/or a yeast infection once in her lifetime, it's comforting news to learn that both infections are generally easy to treat.

Although 30% of BV cases may resolve without treatment, this condition is usually treated with antibiotics, most commonly metronidazole or clindamycin. Both of these medications are effective whether taken by mouth or applied vaginally. And because BV is not considered an STI, symptom-free partners do not need to be treated, and there is no risk of passing the infection back and forth.

Similarly, most yeast infections with mild to moderate symptoms are simple to treat, and there are numerous over-the-counter antifungal medications, like miconazole (Monistat), terconazole, or clotrimazole, that are highly effective. But for lingering or repeat infections, your provider may prescribe a stronger oral antifungal medicine like fluconazole (Diflucan).

As always, it is best practice to consult with your healthcare provider before embarking on an at-home treatment for a yeast infection. That said, treating yourself for a suspected yeast infection at home is probably okay if this is not your first yeast infection, the symptoms are familiar to you, you are not pregnant, and you don’t suspect an STI from recent sexual contact.

While treating BV or yeast infections is fairly straightforward, there are many practical lifestyle modifications and measures to help prevent these infections in the first place.

Preventive measures for BV:

• Limit number of sexual partners
• Avoid douching
• Use condoms

Preventive measures for yeast infections:

• Avoid tight clothing that can trap moisture
• Change out of wet clothing after swimming or working out
• Limit use of antibiotics. It’s a good idea to eat yogurt with live cultures or take Lactobacillus acidophilus tablets when you are on antibiotics.

There are other lifestyle changes that will support in preventing both kinds of infections and promote overall vaginal health and wellbeing. Some include:

• Wear cotton-lined or cotton underwear. Bacteria and fungi thrive in warm, moist environments and cotton wicks away moisture.
• Avoid scented soaps, feminine hygiene products, and toilet paper
• Avoid bubble baths, hot tubs, and very hot baths
• Avoid feminine hygiene sprays, fragrances, or powders in the genital area
• Rinse genitals with water and pat dry
• Take probiotics
• Keep your blood sugar level under control if you have diabetes

If you have a vagina, BV and yeast infections are common infections that can arise when there is an imbalance in naturally-occurring bacteria in the vagina. Although they share symptoms – vaginal discharge, itching, and burning – BV is caused by overgrowth of bacteria (and treated with antibiotics) while yeast infections are caused by an overgrowth of fungus (and treated with antifungal agents). BV is usually associated with sexual activity, and risk factors include: multiple sexual partners and not using barrier contraception, like condoms. Yeast infections have been linked to antibiotic use, high estrogen levels, and a weakened immune system. But really, either infection can occur at any time without obvious reasons.