What patient education can be provided for bacterial vaginosis (BV) vs yeast infection?

Patient Education for Bacterial Vaginosis vs. Yeast Infection

The key differences between bacterial vaginosis (BV) and yeast infection are in their symptoms, causes, and treatments - BV typically presents with a fishy odor and thin white discharge, while yeast infections cause itching, burning, and thick white discharge. 1, 2

Symptoms and Characteristics

Bacterial Vaginosis

• BV is characterized by a thin, homogeneous, white discharge that smoothly coats the vaginal walls 3, 1
• A distinctive fishy odor is present, especially after intercourse or during menstruation 1, 4
• BV typically has minimal vulvar irritation or itching 1
• Up to 50% of women with BV may be asymptomatic 3, 1
• Vaginal pH is elevated (>4.5) 3, 1

Yeast Infection (Vulvovaginal Candidiasis)

• Characterized by itching, burning, and vulvar or vaginal erythema 5, 6
• Thick, white, cottage cheese-like discharge that doesn't typically have a strong odor 2, 5
• May cause painful urination and intercourse 5, 6
• Normal vaginal pH (≤4.5) 3, 2
• Affects approximately 75% of women at least once in their lifetime 6

Causes and Risk Factors

Bacterial Vaginosis

• Results from replacement of normal Lactobacillus bacteria with anaerobic bacteria, Gardnerella vaginalis, and Mycoplasma hominis 3, 1
• Associated with multiple sexual partners and douching 3, 1
• Not considered exclusively sexually transmitted, but rarely affects women who have never been sexually active 3
• A change in sexual partner significantly increases risk of BV recurrence (77 times higher risk) 7

Yeast Infection

• Primarily caused by Candida albicans fungus 2, 5
• Risk factors include antibiotic use, pregnancy, diabetes, and immunosuppression 5, 6
• Not typically considered sexually transmitted 3, 2
• 40-45% of women experience two or more episodes 2

Self-Diagnosis Tips

• BV can be suspected with fishy odor and thin discharge without significant itching 1, 4
• Yeast infections typically present with intense itching and thick discharge without strong odor 5, 6
• Neither condition should be self-diagnosed if:
  • It's the first vaginal infection
  • There are additional symptoms like fever, abdominal pain, or unusual bleeding
  • The patient is pregnant
  • Symptoms don't improve with over-the-counter treatment 6

Treatment Options

Bacterial Vaginosis

• Requires prescription antibiotics - not available over-the-counter 1, 4
• Common treatments include:
  • Metronidazole 500 mg orally twice daily for 7 days (95% cure rate) 4, 8
  • Metronidazole gel 0.75% intravaginally once daily for 5 days 4, 2
  • Clindamycin cream 2% intravaginally at bedtime for 7 days 4, 2
• Important: Avoid alcohol during metronidazole treatment and for 24 hours afterward 4
• High recurrence rate (50-80% within a year) 1, 8
• Treatment of male partners is not recommended as it doesn't prevent recurrence 3, 1

Yeast Infection

• Over-the-counter antifungal treatments are available 5, 6
• Treatment options include:
  • Topical azole medications (creams, suppositories) 5, 6
  • Oral fluconazole (prescription) 5, 6
• For recurrent infections (4+ episodes per year), maintenance therapy with weekly oral fluconazole for up to 6 months may be needed 6

When to Seek Medical Care

• If symptoms don't improve with over-the-counter treatment 6
• If there's uncertainty about the diagnosis 3, 2
• If symptoms recur frequently 1, 6
• If pregnant, as BV is associated with preterm birth and other pregnancy complications 2, 6
• If experiencing unusual symptoms like fever, abdominal pain, or abnormal bleeding 6

Prevention Strategies

• Avoid douching and irritating feminine products 1, 8
• Wear cotton underwear and avoid tight-fitting clothing 5
• Consider probiotic supplements containing Lactobacillus species, though evidence for effectiveness is limited 2, 7
• Maintain good hygiene but avoid excessive washing with soap in the vaginal area 5
• Use condoms to reduce risk of BV, especially with new partners 7