Sometimes vaginitis—or vaginal inflammation—can be so mild you may not think anything out of the norm is happening. Other times, vaginitis is accompanied by pain and discomfort, which may point to a yeast infection or bacterial vaginosis.
The problem? Both issues share common symptoms, which can make it hard to distinguish which one you are experiencing.
Rachel Urrutia, MD, an OB-GYN at UNC Medical Center and assistant professor at the UNC School of Medicine, explains the difference between the two and when you should see a doctor.
What Is a Yeast Infection?
A yeast infection is when the yeast naturally present on your body, usually a type called candida, grows out of control and causes an infection in your vagina and/or vulva. It can happen for a variety of reasons, including a compromised immune system, more frequent sex or pregnancy. Some people, such as those with diabetes, are also more prone to yeast infections.
Yeast infections are not sexually transmitted infections (STIs), but sex can lead to a yeast infection, as intercourse can cause small breaks in the skin that allow more yeast to grow.
Symptoms of a yeast infection include a thick, white vaginal discharge, itching, burning and redness. Sex with a yeast infection can be painful, and it may hurt when you pee.
Three out of 4 women will have a yeast infection at some point in their life, and most are mild. However, they can develop into more serious infections in some cases.
What Is Bacterial Vaginosis?
Bacterial vaginosis (BV) is a bacterial infection in the vagina, which is home to a variety of bacteria.
BV is caused by an imbalance of that bacteria. When too much of a certain type of bacteria, including a strain called gardnerella vaginalis, is present, it can lead to an infection. BV is not an STI, but because it is caused by an imbalance, sex can lead to BV by changing the pH in the vagina or by transferring bacteria.
BV symptoms can be similar to those of a yeast infection. You may experience itching, burning when you pee and abnormal discharge. Unlike yeast infection discharge, BV discharge can be smelly and discolored.
BV is the most common form of bacterial vaginal infection in women ages 15 to 44. If left untreated, BV can cause other health complications.
Preventing Infection
Because these forms of vaginitis are caused by imbalances in the vagina, try to be conscious of anything you are doing that could disrupt the microbiome in that part of your body. For example, do not douche. Doctors recommend only using water and washing only the outside of the genital area, as soaps and deodorants can upset the balance of yeast and bacteria. If you think your infections might be related to sex, talk to your physician.
Dr. Urrutia says one of the best things you can do for vaginal health is pay attention to what’s happening “down there” on a regular basis. Throughout your menstrual cycle the body provides clues as to what’s happening inside. Certain stages of your cycle can cause dryness or discharge. Knowing what is normal for your body can help you determine if you have an infection or are just entering a different stage of your cycle.
Also, itchiness and abnormal discharge are symptoms of some STIs. If you think you could have contracted an STI, get tested. Dr. Urrutia says it is possible to have an STI and yeast infection or BV at the same time.
When to Go to the Doctor
Because yeast infections and BV have such similar symptoms, it can be hard to tell which you are experiencing, and self-diagnosing is often inaccurate, Dr. Urrutia says.
Dr. Urrutia recommends watching your symptoms for a few days before taking any action. This ensures that you aren’t just experiencing a normal part of your menstrual cycle.
If you believe you may have a yeast infection, Dr. Urrutia says it’s OK to try an over-the-counter (OTC) antifungal medication before making an appointment with your doctor—as long as the medication is longer than a one-day treatment.
“Do not use the one-day treatments because they are not as effective as the longer-course treatments,” she says. “You should at least be using the three-day treatment.”
It can take up to a week and a half for yeast infection symptoms to go away, but you should see some improvement within a week, Dr. Urrutia says. If your symptoms don’t improve, it’s time to go to the doctor.
Unlike yeast infections, you cannot take OTC medication for BV. If you think you might be experiencing BV, talk to your doctor, who can prescribe the appropriate medication.
Treatments for Yeast Infections and BV
Doctors usually diagnose vaginal infections by taking your history and checking a vaginal swab.
As mentioned, yeast infections can be treated with OTC antifungal medications, which come in many forms, including pills, creams and suppositories that are inserted into the vagina. Your doctor may also prescribe oral antifungal medication.
BV is treated with antibiotics that are only available with a prescription. You should see improvements in your symptoms within a day or two of starting treatment.
In either case, if your symptoms aren’t improving within a week of starting medication, follow up with your doctor, as he or she may need to reexamine the diagnosis or try a different treatment.
If you suspect a yeast infection that doesn’t get better quickly or BV, talk to your primary care doctor or OB-GYN. If you’d like to make an appointment with an OB-GYN, you can find one here.