The two most common vaginal infections are bacterial vaginosis (BV) and yeast infections (also known as vulvo-vaginal candidiasis, VVC or thrush).

In fact, about 75% of women will have a vaginal yeast infection in their lifetime, and about 30% of women will experience bacterial vaginosis.

Bacterial vaginosis is caused by pathogenic bacteria whereas vaginal yeast infections are caused by the fungus Candida. As these two conditions are caused by different group of organisms – bacteria vs fungus - it is important to establish which type of infection you have so you can adopt the most appropriate and effective treatment.

In this article we cover similarities and differences between:

  • Symptoms of BV and thrush
  • Treatment of BV and thrush
  • Risk factors that contribute toward BV and thrush
  • Diagnosis and clinical presentation of BV and thrush

What is the Easiest Way to Know if You Have Bacterial Vaginosis (BV) Or a Yeast Infection (Thrush)?

Something is wrong with your vagina, but you aren’t sure if it’s bacterial vaginosis or a yeast infection? Here are some key symptoms to lookout for which will help you to determine which type of infection you have.

The top ways you can tell the difference are:

  1. Abnormal vaginal discharge – If it’s green/grey in colour, smells fishy and is thin and watery inconsistency you are most likely to have bacterial vaginosis. On the other hand, if your discharge is thick, looks like cottage cheese but has no odour, plus your vagina feels sore and itchy and you feel a burning sensation when passing urine, then you are most likely to have thrush.
  2. Odour – BV has a distinct fishy odour whereas yeast infections generally don’t have an offensive or any odour. 

Your Simple Checklist - Comparing Symptoms of BV and Thrush

Comparing Symptoms of Bacterial Vaginosis and Thrush (Vaginal Yeast Infections)

What are the Options for Treating Bacterial Vaginosis and Thrush

Once you have determined that you have either bacterial vaginosis or thrush, the next step is treatment.

If you have gotten your diagnosis from a medical practitioner, they will most likely suggest that bacterial vaginosis is to be treated with a course of antibiotics, either taken orally or applied as a cream. In Australia you may be prescribed Metronidazole oral tablets or Metronidazole cream to treat BV. Another antibiotic cream that may be prescribed is Clindamycin.

For vaginal yeast infections (thrush) you will be prescribed one of three vaginal creams: Vaginal Clotrimazole, Vaginal Miconazole or Vaginal Teroconazole. Alternatively, you may be prescribed oral Fluconasole (anti-fungal tablets).

While you may come across suggested “home remedies” for treating both conditions it is important to know that these are not proven to work. Some examples? Using yogurt or apple cider vinegar to treat bacterial vaginosis or vaginally applied boric acid to treat thrush: there isn’t enough scientific evidence or clinical studies to support their use.

A third approach is the use of vaginal probiotics to help rebalance the good bacteria in the vagina’s flora. Vaginal probiotics can provide support in both BV and thrush. There are many clinical studies which confirm that vaginal probiotics both improve clinical symptoms and restore a healthy vaginal microbiome1. Vaginal probiotics are recommended in supporting vaginal microbiome when it comes to VVC (thrush) recurrence, and where side effects or contraindications prevent the use of anti-fungal treatments2.

Your Simple Checklist - Treatment Options for Bacterial Vaginosis and Thrush

Sometimes you do everything right and still experience vaginal symptoms. But here are some factors which may increase your risk of getting bacterial vaginosis or yeast infections.

What Factors Increase My Risk of Getting Bacterial Vaginosis?

With bacterial vaginosis, the main risk factors are vaginal irritation caused by over-washing, vaginal douching and sexual activity. Use of hygiene products like vaginal washes, soaps, deodorants, lubricants and tampons can also be the cause. It has been established that an increased number of sexual partners and intimate sexual contact with females also heightens your risk of developing BV3.

Additional things that may be factor for developing BV include hormonal changes triggered by your menstrual cycle, during pregnancy and menopause; hormone replacement therapy; use of birth control pill; use of antibiotics and spermicides. Those undertaking immunosuppression treatment and suffering from diabetes are also at greater risk of BV, as are persons with African-American and Hispanic heritage with studies showing they are more likely to experience BV4.

Diet also plays a factor – a diet high in fat and sugars (high intake of sweets and saturated fats), low in folate, vitamins A, C, D, E, calcium and beta-carotene5 puts you at greater risk of contracting bacterial vaginosis too.

What Factors Increase My Risk of Getting Thrush?

‍With thrush the main risk factors are hormonal changes including pregnancy, menopause, monthly cycle (just before period6) and sexual activity– in particular receptive oral sex, receptive anal sex, use of sex toys and aids7.

Use of hygiene products like vaginal washes, soaps, deodorants, lubricants and tampons can also be a risk factor for thrush.

Those undertaking immunosuppression treatment, extensive antibiotic treatment and suffering from diabetes are also more prone to thrush infections, as well as African-American women in comparison to European or Hispanic women8.

Diet also plays a factor with thrush – a diet high in fat and sugars, low in folate, vitamins A, C, D, E, calcium and beta-carotene5 (indicating low intake of fruits and vegetables) puts you at greater risk of developing thrush.

Your Simple Checklist - Risk factors that contribute towards Bacterial Vaginosis and Vaginal Yeast Infections

How are Bacterial Vaginosis and Thrush Diagnosed & How Often Do They Reoccur?

When you visit your GP or medical practitioner to establish if you have bacterial vaginosis or thrush they will check the pH level of your vagina, your discharge colour, consistency and odour. Plus they will take a vaginal swab to send it to a lab to gain analysis of the discharge to determine if it is BV or thrush.

If you have BV the pH level in your vagina will be greater than 4.5, while with thrush the pH in your vagina could be in the normal range of 3.8-4.5, or even lower than 3.8.

Discharge is one of the strongest indicators on if you have bacterial vaginosis or thrush – your doctor will want to know if your discharge looks grey or green and if it has a fishy odour (indicating bacterial vaginosis) or if it is white, thick and looks like cottage cheese but with no odour (indicating thrush).

A vaginal sample that is sent to a lab and analysed will show if you have bacterial pathogens (BV) or if you are Candida positive (have thrush).

It’s important to have the facts on recurrency: after experiencing BV for the first time over 50% of women will have a relapse within one year. While one in ten women will have four or more episodes of thrush within one year.

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See list of references used on this page

1  Wang Z, He Y, Zheng Y. Probiotics for the Treatment of Bacterial Vaginosis: A Meta-Analysis. Int J Environ Res Public Health. 2019 Oct 12;16(20):3859.

2 Falagas ME, Betsi GI, Athanasiou S. Probiotics for prevention of recurrent vulvovaginal candidiasis: a review. JAntimicrobChemother. 2006 Aug;58(2):266-72.

3 Fethers KA, Fairley CK, Hocking JS, Gurrin LC, Bradshaw CS. Sexual risk factors and bacterial vaginosis: a systematic review and meta-analysis. Clin Infect Dis. 2008 Dec 1;47(11):1426-35.

4 Koumans EH, Sternberg M, Bruce C, McQuillan G, Kendrick J, Sutton M, Markowitz LE. The prevalence of bacterial vaginosis in the United States, 2001-2004; associations with symptoms, sexual behaviors, and reproductive health. Sex Transm Dis. 2007 Nov;34(11):864-9.    

5 Mizgier M, Jarzabek-Bielecka G, Mruczyk K, Kedzia W. The role of diet and probiotics in prevention and treatment of bacterial vaginosis and vulvovaginal candidiasis in adolescent girls and non-pregnant women. GinekolPol. 2020;91(7):412-416. 

6 Hetal B Gor. Vaginitis., Jul 09, 2021.

7 Bradshaw CS, Morton AN, Garland SM, Morris MB, Moss LM, Fairley CK. Higher-risk behavioral practices associated with bacterial vaginosis compared with vaginal candidiasis. ObstetGynecol. 2005 Jul;106(1):105-14.

8 Rosati D, Bruno M, Jaeger M, Ten Oever J, Netea MG. Recurrent Vulvovaginal Candidiasis: An Immunological Perspective. Microorganisms. 2020 Jan 21;8(2):144.