Thrush or Bacterial Vaginosis (BV)
The difference between thrush and bacterial vaginosis
Last reviewed: 11 Apr 2019
Bacterial vaginosis (BV) and thrush are the two most common vaginal infections. You usually get these infections when there’s a change in the bacteria that normally live in the vagina, but it’s not always clear what causes this to happen.
BV and thrush can both cause similar symptoms and can be mistaken for each other, and even for some sexually transmitted infections that also cause the same symptoms. If you get any symptoms of BV, thrush, or STIs, and you’re not sure which you have, then you should see your doctor. They can figure out which infection you have and give you advice on next steps.
What’s the difference between thrush and bacterial vaginosis (BV)?
Normally, different kinds of fungus live in the digestive system, and other parts of the body, like the mouth, skin, and vagina. Most of the time they don’t cause symptoms, but sometimes there’s overgrowth and this can lead to an infection. Thrush is a very common vaginal infection, which happens when there’s too much of the Candida albicans fungus.
You’re more likely to get thrush if you:
- are pregnant
- wear tight or synthetic clothing
- are taking antibiotics
- have illnesses that affect your immune system
- use products that can irritate the vagina, like scented bubble bath or shower gel
Bacterial vaginosis is a type of inflammation that occurs in the vagina when there’s overgrowth of bacteria that live naturally in the vagina, and the natural balance on the vagina’s environment is upset.
Women between puberty and menopause are most likely to get bacterial vaginosis, but it can affect women of any age. Even though the exact cause of BV isn’t known, certain things can increase your risk, like unprotected sex or frequent douching. It’s also common for BV to come back after it clears up, usually within 3 months.
You’re more likely to get bacterial vaginosis if you use:
- medicated or scented soaps, bubble bath, or shower gel
- antiseptic liquids in the bath
- vaginal deodorant
- strong cleaning detergents to wash your underwear
What do thrush and BV have in common?
Both thrush and BV are more likely to happen when there’s a change to the vagina’s natural environment. This change can happen for similar reasons, like vaginal cleaning products, irritation of the vagina, or a weak immune system.
It can be difficult to tell between thrush and BV, since they also cause some similar symptoms, including:
- unusual vaginal discharge (liquid coming from your vagina)
- a burning sensation, or pain when peeing
Thrush and BV also share these symptoms with some STIs as well.
How can you tell which one you have?
Both BV and thrush can cause an unusual vaginal discharge, but there are some differences in this discharge, and other symptoms, which might help you tell which you have.
BV symptoms that are different from thrush:
- The vaginal discharge for BV is often white-grey in colour, watery, and has a fishy smell, which may be more noticeable during sex or after your period
- BV isn’t doesn’t usually cause strong itching or discomfort around the vagina
Thrush symptoms that are different from BV:
- The vaginal discharge is for thrush is thick, creamy white, curd-like, and doesn’t have a smell
- Intense itching, redness, discomfort or pain around the vagina
Even though there are some different symptoms between BV and thrush, the most reliable way to tell which one you have is to check with a doctor. Symptoms can vary between people, and your doctor will have more experience telling between these conditions than you.
Could it be something else?
Yes. It’s not always easy to tell if you have thrush, BV, or another condition. This can be because other conditions can also cause similar symptoms to thrush or BV, making it harder to tell between them.
In particular, some sexually transmitted infections can cause similar symptoms. Chlamydia is an example, and at least 70% of women with it don't notice any symptoms. If they do get symptoms, the most common include pain when urinating and unusual vaginal discharge.
Can you treat thrush and BV the same way?
You can’t treat thrush and BV in the same way, since each condition is caused by a different type of organism.
Thrush is caused by a fungus, so treatments include:
- antifungal thrush medications: these come as tablets you swallow, tablets you insert into your vagina (pessaries), or internal or external creams for the affected areas, or taken together as combination treatments like Canesten Combi or Canesten Duo
- home thrush remedies: there are some treatment options for people who don’t want medication, including yoghurt and honey, boric acid, garlic, coconut oil, probiotics, and vitamin C
- moisturisers: you can get creams to use on the skin around the entrance to the vagina, which can help with itchiness and soreness
BV is caused by bacteria, so treatments include antibiotics:
- Metronidazole: this can be taken as an oral tablet you swallow, or as a gel you use on your vagina (Zidoval)
- Clindamycin: this comes as a cream that you insert into your vagina (Dalacin)
If you know you’re pregnant, or you think you might be, you should check with your doctor before starting any treatments for thrush or BV.
Which treatment should I go for?
If you’ve had a diagnosis for BV or thrush in the past, you can order treatment for that condition online with Zava. If you haven’t had a diagnosis before or you’re not sure which infection you have then you should see your doctor.
There are home tests kits available for BV and thrush together (Canetest) if you’d prefer to diagnose yourself. Many tests offer results straight away and have clear instructions. Based on your results, you might be able to see which treatment to go for, but if you’re not sure then see your doctor.
At Zava, we always recommend seeing a doctor first if you’ve not been diagnosed before. In some situations, your test might not give you an accurate diagnosis, for example if:
- it’s less than one day before or after your period is supposed to happen
- you’ve had signs of vaginal bleeding or an irregular period
- you’ve had sex less than 12 hours ago
Also if you’re pregnant, you need to see your doctor before starting any treatment.
When to see a doctor in person
You should see a doctor in person if you don’t want to order treatment online, you don’t have a previous diagnosis of the infection you think you have, or you’re not sure which infection you have this time. There are also other reasons why you should choose to see a doctor in person about your thrush or BV.
You should see a doctor in person if you want extra treatment options or advice, for example:
- you need a longer treatment
- the first treatment course you use doesn’t work: the doctor or nurse may suggest another test or a combination of treatments
- you haven’t been able to take your treatment properly, for example you’ve missed some doses
- you think your infection may have come back again
You should also see a doctor if you’re not sure if you have an STI or not:
- Even if your BV or thrush infections clear up there are health risks to having an untreated STI
- Treatment might not be necessary if your symptoms are actually being caused by an STI: this is especially important for antibiotic treatments for BV because of the risk of antibiotic resistance that comes from using antibiotics when you don’t need them
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NHS (2018). Chlamydia. [online] Available at: https://www.nhs.uk/conditions/chlamydia/symptoms/ [accessed 28th March 2019].
NHS (2017). Thrush in men and women. [online] Available at: https://www.nhs.uk/conditions/thrush-in-men-and-women/ [accessed 28th March 2019].
NHS (2018). Chlamydia. [online] Available at: https://www.nhs.uk/conditions/bacterial-vaginosis/ [accessed 28th March 2019].
NICE (2018). Bacterial vaginosis. [online] Available at: https://cks.nice.org.uk/bacterial-vaginosis#!scenario [accessed 28th March 2019].