Symptoms of Bacterial Vaginosis (BV) vs. Yeast Infection
The key difference between bacterial vaginosis and yeast infection is that BV typically presents with a thin, white/gray discharge with fishy odor and minimal irritation, while yeast infections present with thick white discharge, significant itching, and vulvovaginal irritation. 1, 2
Bacterial Vaginosis (BV) Symptoms
BV is characterized by:
- A homogeneous, thin, white or gray discharge that smoothly coats the vaginal walls 3
- Fishy odor, especially noticeable after intercourse or during menstruation 3, 2
- Vaginal pH greater than 4.5 3, 4
- Minimal to no vulvar itching or irritation 2
- Up to 50% of women with BV may be asymptomatic 3, 2
- Absence of significant inflammation 3
BV results from a replacement of normal H₂O₂-producing Lactobacillus species with anaerobic bacteria, Gardnerella vaginalis, and Mycoplasma hominis 3, 2.
Yeast Infection (Vulvovaginal Candidiasis) Symptoms
Yeast infections typically present with:
- Thick, white, cottage cheese-like discharge that doesn't coat vaginal walls 1, 5
- Significant itching and burning in the vulvovaginal area 5
- Vulvar or vaginal erythema (redness) 5
- Pain during sexual intercourse 5
- Stinging or burning during urination 5
- Normal vaginal pH (≤4.5) 3, 1
- No fishy odor 1, 5
Yeast infections are primarily caused by Candida albicans and affect approximately 75% of women at least once in their lifetime 1.
Key Diagnostic Differences
The following features help differentiate between the two conditions:
- Discharge appearance: BV has thin, homogeneous discharge that coats vaginal walls; yeast infections have thick, clumpy discharge 3, 5
- Odor: BV has a characteristic fishy odor, especially after adding 10% KOH (positive whiff test); yeast infections typically have no distinct odor 3
- Itching/irritation: Minimal in BV; prominent in yeast infections 2, 5
- pH: Elevated (>4.5) in BV; normal (≤4.5) in yeast infections 3, 4
- Microscopic findings: BV shows "clue cells" (epithelial cells covered with bacteria); yeast infections show yeast forms or pseudohyphae 3
Clinical Significance
- BV is associated with increased risk for pelvic inflammatory disease, preterm birth, and increased susceptibility to STIs 2, 6
- Yeast infections, while uncomfortable, rarely lead to serious complications 6
- Both conditions can recur, with BV having a particularly high recurrence rate (50-80% within a year) 2, 7
Common Pitfalls in Diagnosis
- Relying solely on symptoms without laboratory confirmation can lead to misdiagnosis 3, 1
- Self-diagnosis and treatment may delay proper care, especially when symptoms overlap with other conditions 5
- Not all vaginal discharge indicates infection; physiologic discharge is normal 6
- The absence of microscopic findings doesn't rule out infection, as PCR testing may detect pathogens missed on microscopy 3
Understanding these distinct symptom patterns helps in appropriate diagnosis and treatment, improving outcomes and reducing unnecessary antibiotic use.