Vaginal Swelling, Redness, and Itching: Distinguishing Between Yeast Infection and Bacterial Vaginosis
Your symptoms of swelling, redness, and itching strongly suggest a yeast infection (vulvovaginal candidiasis) rather than bacterial vaginosis, because BV characteristically presents WITHOUT significant vulvar inflammation. 1
Key Diagnostic Distinction
The presence or absence of vulvar inflammation is the critical differentiating feature:
- Yeast infection (Candidiasis) presents with vulvar pruritus, erythema, swelling, and excoriation—exactly matching your symptoms of swelling, redness, and itching 2, 3
- Bacterial vaginosis is characterized by a homogeneous white discharge with fishy odor but specifically lacks significant vulvar inflammation 4, 1
The CDC explicitly states that the absence of significant vulvar inflammation distinguishes BV from other causes of vaginitis 1. Since you have prominent vulvar symptoms (swelling, redness, itching), this points away from BV.
What You Should Look For
Discharge characteristics help confirm the diagnosis:
- Yeast infection: Thick, white, "curdled" or cottage cheese-like discharge with normal vaginal pH (3.8-4.5) 2, 5
- Bacterial vaginosis: Thin, homogeneous white discharge that coats vaginal walls, with fishy odor and elevated pH (>4.5) 4, 1
The "whiff test" (fishy odor):
- Fishy odor suggests BV or trichomoniasis, NOT yeast 4, 1
- Absence of fishy odor supports yeast infection 2
Critical Pitfall: Don't Miss Trichomoniasis
While less likely, trichomoniasis can also cause itching and vulvar irritation with a frothy, greenish discharge 1, 2. However, this typically includes profuse discharge and is sexually transmitted, requiring partner treatment 6, 3.
Recommended Action
You need proper diagnosis before treatment:
- Measure vaginal pH with narrow-range pH paper: normal (3.8-4.5) confirms yeast; elevated (>4.5) suggests BV or trichomoniasis 1, 3
- Microscopic examination can identify yeast/pseudohyphae (candidiasis), clue cells (BV), or motile trichomonads (trichomoniasis) 4, 1
- Nucleic acid amplification testing (NAAT) for gonorrhea, chlamydia, and trichomonas should be considered, as these can also cause vaginal discharge 6
Treatment Once Diagnosed
For yeast infection (most likely based on your symptoms):
- Oral fluconazole 150mg single dose OR topical azole creams (clotrimazole, miconazole, butoconazole) are equally effective 6, 3
- If pregnant, use only topical azoles 6, 3
For bacterial vaginosis (if diagnosed):
- Metronidazole 500mg orally twice daily for 7 days is the standard treatment 4, 6
- Alternative: metronidazole vaginal gel or clindamycin cream 6, 3
Important caveat: Approximately 15% of Candida albicans organisms are resistant to clotrimazole and miconazole 2. If symptoms persist after treatment, culture can identify non-albicans Candida species requiring different therapy 3.