You notice an uncomfortable itch. Then, a change in your vaginal discharge. Your first instinct is probably to head to the pharmacy for an over-the-counter yeast infection treatment. It is what most women do.
But what if it is not a yeast infection?
Bacterial vaginosis (BV) and yeast infections are the two most common causes of vaginitis (vaginal inflammation). [1] Because they share some overlapping symptoms—like itching, irritation, and abnormal discharge—they are frequently confused. However, they are caused by entirely different organisms and require completely different treatments.
Treating BV with a yeast infection cream will not work, and it can actually make your symptoms worse by further disrupting your vaginal microbiome. Here is how to tell the difference between the two and why getting an accurate diagnosis matters.
The Root Cause: Bacteria vs. Fungus
Your vagina is home to a complex, delicate ecosystem of microorganisms. In a healthy state, “good” bacteria (primarily lactobacilli) keep “bad” bacteria and yeast in check by maintaining a slightly acidic environment. [2]
A yeast infection (candidiasis) occurs when there is an overgrowth of a fungus called Candida. This fungus naturally lives in your vagina in small numbers, but factors like antibiotic use, pregnancy, uncontrolled diabetes, or a weakened immune system can cause it to multiply rapidly. [3]
Bacterial vaginosis (BV), on the other hand, is not caused by a fungus. It happens when the normal balance of bacteria in your vagina is disrupted, and certain types of “bad” bacteria (often Gardnerella vaginalis) overgrow and outnumber the good lactobacilli. [4] BV is the most common vaginal infection in women ages 15 to 44. [5]
How to Tell the Difference: The Symptoms
While both conditions cause discomfort, the specific symptoms are usually distinct enough to tell them apart if you know what to look for.
The Discharge
This is often the most reliable indicator.
- Yeast Infection: The discharge is typically thick, white, and clumpy, often described as resembling cottage cheese. It usually does not have a strong odor. [1]
- BV: The discharge is usually thin, watery, and grayish-white or yellow. [6]
The Odor
- Yeast Infection: Generally odorless, or it may have a mild, yeasty (bread-like) smell.
- BV: The hallmark symptom of BV is a strong, distinct “fishy” odor. This odor often becomes much more noticeable after sexual intercourse or during your period, as semen and blood alter the vaginal pH. [7]
The Discomfort
- Yeast Infection: Intense itching and burning of the vulva and vagina are the primary complaints. The vulva may also appear red and swollen. [1]
- BV: While BV can cause mild itching or burning, especially during urination, it is generally less intensely irritating than a yeast infection. Many women with BV experience no itching at all, only the abnormal discharge and odor. [8]
Why Accurate Diagnosis Matters
If you have had a yeast infection before and recognize the classic “cottage cheese” discharge and intense itching, an over-the-counter antifungal cream is often a reasonable first step.
However, if your symptoms are ambiguous, if you have that distinct fishy odor, or if the OTC treatment does not work within a few days, you need to see your provider.
BV cannot be cured with over-the-counter medications. It requires prescription antibiotics, either oral pills (like metronidazole) or a vaginal gel or cream. [9]
Leaving BV untreated is not just uncomfortable; it carries real health risks. Untreated BV increases your susceptibility to sexually transmitted infections (STIs), including HIV, chlamydia, and gonorrhea. [10] If you are pregnant, untreated BV is linked to an increased risk of premature rupture of membranes, preterm birth, and low birth weight. [11]
Prevention and Next Steps
Both BV and yeast infections are signs that your vaginal microbiome is out of balance. To help maintain a healthy environment:
- Avoid douching, which strips away the good bacteria. [12]
- Use mild, unscented soaps on your vulva (and never inside the vagina).
- Wear breathable cotton underwear and avoid tight, restrictive clothing.
- Change out of wet swimsuits or sweaty workout clothes promptly.
If you are experiencing vaginal discomfort, abnormal discharge, or a noticeable odor, do not guess in the pharmacy aisle. Schedule an appointment with Women’s Integrated Healthcare. We can quickly and accurately diagnose the cause of your symptoms and prescribe the correct treatment to get you back to feeling comfortable and confident.
References
[1] American College of Obstetricians and Gynecologists. (2024). Think You Have a Vaginal Infection? Here’s What You Need to Know. https://www.acog.org/womens-health/experts-and-stories/the-latest/think-you-have-a-vaginal-infection-heres-what-you-need-to-know [2] Office on Women’s Health. (2022). Bacterial vaginosis. https://womenshealth.gov/a-z-topics/bacterial-vaginosis [3] American College of Obstetricians and Gynecologists. (2024). Vaginitis. https://www.acog.org/womens-health/faqs/vaginitis [4] Centers for Disease Control and Prevention. (2023). About Bacterial Vaginosis (BV). https://www.cdc.gov/bacterial-vaginosis/about/index.html [5] Centers for Disease Control and Prevention. (2021). Bacterial Vaginosis – STI Treatment Guidelines. https://www.cdc.gov/std/treatment-guidelines/bv.htm [6] Healthline. (2019). Bacterial Vaginosis vs. Yeast Infection: Symptoms, Treatment, More. https://www.healthline.com/health/bacterial-vaginosis-vs-yeast-infection [7] Roswell Ob/Gyn. (2026). Yeast Infection vs. BV Differences. https://roswellobgyn.org/yeast-infection-vs-bv-how-to-tell-the-difference/ [8] Advanced Gynecology. (2024). Bacterial Vaginosis Vs. Yeast Infections: Differences and Similarities. https://advancedgynecology.com/blog/bacterial-vaginosis-vs-yeast-infections-differences-and-similarities [9] Mayo Clinic. (2023). Bacterial vaginosis – Diagnosis and treatment. https://www.mayoclinic.org/diseases-conditions/bacterial-vaginosis/diagnosis-treatment/drc-20352285 [10] World Health Organization. (2025). Bacterial vaginosis. https://www.who.int/news-room/fact-sheets/detail/bacterial-vaginosis [11] Centers for Disease Control and Prevention. (2024). Bacterial Vaginosis – CDC Fact Sheet. https://stacks.cdc.gov/view/cdc/32737/cdc_32737_DS1.pdf [12] New York State Department of Health. (2024). Bacterial Vaginosis: What Women Need to Know. https://www.health.ny.gov/publications/3831/
