Bacterial Vaginosis (BV) and vaginal yeast infections (candidiasis) are common causes of vaginitis, or inflammation of the vagina. While both conditions share general symptoms like discharge and discomfort, they are fundamentally different infections requiring distinct diagnosis and treatment. Understanding the specific causes and manifestations of each is necessary for effective medical intervention.
The Underlying Causes
Bacterial Vaginosis results from a shift in the vaginal microbiome, the delicate balance of bacteria naturally present in the vagina. This condition is characterized by a significant decrease in protective Lactobacillus bacteria and an overgrowth of various anaerobic bacteria, such as Gardnerella vaginalis. While not considered a sexually transmitted infection, the risk of developing BV is associated with activities like douching, having multiple sexual partners, or having a new sexual partner.
The change in bacterial population directly affects the vaginal environment’s acidity. A healthy vagina is moderately acidic, typically maintaining a pH between 3.8 and 4.5. In contrast, BV is associated with an elevated vaginal pH, usually rising above 4.5, which encourages the proliferation of non-beneficial bacteria.
A yeast infection is a fungal infection caused by the excessive multiplication of Candida species, with Candida albicans being the most common culprit. This fungus is normally present in the body, but an environmental change allows it to multiply uncontrollably. Factors like antibiotic use, hormonal fluctuations, or a weakened immune system can disrupt the natural balance that keeps Candida in check.
Unlike BV, yeast infections typically occur when the vaginal pH is within the normal or slightly acidic range. The issue is not a bacterial imbalance but an overgrowth of fungus, often enabled by the absence of healthy bacteria that would otherwise suppress its growth.
Distinguishing Symptoms and Presentation
The hallmark symptom of BV is a thin, watery vaginal discharge that is typically gray or white. This discharge is often accompanied by a strong, distinctly “fishy” odor, which can become more noticeable after sexual intercourse or during menstruation.
While some mild irritation may occur with BV, intense itching, burning, and soreness of the vulva are usually absent or minimal. The discomfort associated with BV tends to be an uncomfortable feeling rather than the severe pain or inflammation seen in a yeast infection.
In contrast, a vaginal yeast infection is characterized by a thick, white vaginal discharge that is frequently described as having a cottage cheese-like or clumpy texture. This discharge is usually odorless or may have a mild, yeasty smell, lacking the strong “fishy” scent specific to BV.
The most prominent complaint associated with a yeast infection is the severe and persistent itching, burning, and irritation of the vulva and vagina. Inflammation and redness are common, and these symptoms may also be accompanied by pain during urination or sexual intercourse.
Necessary Medical Treatment
Bacterial Vaginosis, being a bacterial overgrowth, is treated exclusively with prescription antibiotics. The most common medications prescribed are metronidazole or clindamycin, administered as oral tablets, vaginal gels, or creams. Completing the full course of antibiotics is necessary to fully clear the infection and reduce the likelihood of recurrence.
Yeast infections, as a fungal overgrowth, are treated with antifungal medications designed to target the Candida fungus. These treatments include prescription options like oral fluconazole, often a single-dose treatment, or various over-the-counter (OTC) products. OTC options typically contain antifungal agents such as miconazole or clotrimazole in the form of creams or suppositories. Using an antifungal treatment for BV is ineffective and can potentially worsen the condition by further disrupting the vaginal environment.
The correct diagnosis is confirmed by a healthcare provider through medical testing, such as a vaginal pH test or a microscopic examination of a discharge sample. This testing ensures the proper intervention is chosen, as mistakenly using an OTC yeast treatment for BV will not resolve the problem and delays necessary antibiotic treatment.