Do I Have BV or Thrush? Identifying Your Symptoms

Key Takeaways

• Thrush and bacterial vaginosis are uncomfortable infections that affect the vagina

• Both infections are related to the normal vaginal environment becoming disrupted

• It's important to visit a healthcare professional if you're experiencing new symptoms, especially if you're sexually active

What Are BV and Thrush?

Bacterial vaginosis (BV) and vaginal candidiasis (thrush) are two common infections affecting the vagina. Whilst both conditions can cause discomfort, they're caused by different things and require different treatments.

What Are the Main Symptoms of BV and Thrush?

BV Symptoms

Bacterial vaginosis is a common bacterial infection, affecting up to 29% of women. It's the most common cause of unusual vaginal discharge. All women have some amount of vaginal discharge, and the consistency and amount changes throughout their cycle. However, the changes caused by BV are different to normal.

The most common symptoms of this vaginal infection include:

• Changes in vaginal discharge (it may become watery, thin, or greyish)

• Discharge having a musty or fishy smell

• A burning sensation when urinating

These symptoms may be worse after sex. Interestingly, up to 50% of women with bacterial vaginosis don't experience any symptoms.

Bacterial vaginosis doesn't usually cause pain or itching - if these symptoms are present, it's important to take a test to rule out sexually transmitted infections.

Thrush Symptoms

Vaginal thrush, often known as a yeast infection, is another common cause of abnormal discharge. Some of the symptoms to keep an eye out for are:

• Thick, white discharge that may look like cottage cheese

• Discharge that smells sweet, yeasty (like bread or beer), or has no smell

• Itching and irritation in and around the vagina

• Pain during or after sex

• Pain when urinating

The fungus that causes thrush can also infect other areas of the skin such as under the armpits, around the groin, and between the fingers. It usually looks like a red rash that's itchy, painful, and discharging a yellow/white substance.

The mouth can also become infected, leading to oral thrush. Oral thrush causes white growths in the mouth, redness, pain, and changes in taste. It's often unrelated to vaginal thrush and is less common.

Comparing Thrush and BV

Thrush and bacterial vaginosis share a lot of similarities, so it can be difficult to tell the two apart. Let's look at the symptoms of the two infections side by side.

1. Discharge Colour
   Thrush - White
   BV - White or grey

2. Discharge Consistency
   Thrush - Thick, like cottage cheese
   BV - Thin and watery

3. Discharge Aroma
   Thrush - Yeasty, sweet, or no smell
   BV - Musky or fishy smell

4. Painful Urination
   Thrush - Sometimes
   BV - Sometimes

5. Itching Around the Vagina
   Thrush - Yes
   BV - Sometimes, but less common

What Causes BV and Thrush?

The vagina is an acidic environment that's full of good bacteria. The pH has to remain acidic to stop the growth of bad bacteria, fungi, and viruses. Similarly, a healthy population of good bacteria is needed to keep the bad bugs at bay.

If either the vaginal pH or microbiome is disrupted, it can lead to infections like BV or thrush.

Causes of Bacterial Vaginosis

BV is caused by an overgrowth of bad bacteria in the vagina. The beneficial bacteria, like Lactobacilli, are outnumbered by species of bad bacteria like Gardnerella. These harmful bacteria reproduce, which may cause discomfort, and can sometimes spread to other areas of the reproductive system.

While BV isn't sexually transmitted, being sexually active does increase your risk of getting it. Having multiple sexual partners, especially if having unprotected sex (without a condom), increases the risk of developing bacterial vaginosis.

Other activities that upset the vagina's natural balance include:

• Douching

• Washing your vagina with perfumed soaps/washes

• Taking hot baths with perfumed bubble bath

• Wearing non-breathable underwear

• Washing your underwear with strong detergents

As menstrual blood has an alkaline pH, some women find they're more likely to experience BV after their periods. Having an IUD, also known as a contraceptive coil, may also increase the risk of getting BV and make an infection more likely to spread to the womb. Finally, smoking also makes it more likely you'll develop BV.

Causes of Thrush

Thrush is a type of yeast infection caused by the overgrowth of the fungus Candida albicans. This fungus is part of the normal vaginal microbiome in many women but can cause problems when it grows too much.

Certain things can increase the risk of developing thrush, including:

• Antibiotic use (especially if long-term)

• Having a weakened immune system

• Having diabetes, especially with poorly controlled blood sugar

• Being pregnant

• Using hormone replacement therapy

Similarly to BV, using scented soaps, detergents, and douching can also increase the risk of getting thrush.

Diagnosis and When to Speak to a Healthcare Professional

It's possible to use a home test to confirm whether you have BV or thrush before starting home treatment. Both the test and treatments are available to purchase from a pharmacy, but this is only advised if:

1. You've had the infection(s) before

2. You're not at risk of having a sexually transmitted infection (STI)

For women who've never experienced these symptoms before, or who have recently had sex with a new sexual partner, it's important to get your symptoms checked by a healthcare professional.

It's easy to mistake the symptoms of an STI for BV or thrush, so it's best to get tested if you're not sure. Your GP or local sexual health clinic can help - find your nearest clinic using this handy tool.

Treatment Options for BV and Thrush

Treating Bacterial Vaginosis

Women with no symptoms don't necessarily need any treatment unless they're pregnant. They may choose to use home treatments and/or try to avoid the factors we mentioned above that can cause BV.

Antibiotics are the main treatment for women with bacterial vaginosis experiencing symptoms. Metronidazole is most commonly prescribed, but other antibiotics like clindamycin may be used in some cases. Metronidazole can be taken as a single large-dose tablet, as a smaller dose over several days, or as a gel inserted into the vagina.

Some women may want treatment even if they're not experiencing symptoms as bacterial vaginosis can increase the risk of catching other vaginal infections and rarely can lead to pelvic inflammatory disease. It's important to discuss this with a doctor.

Treating Thrush

Thrush is often very itchy and uncomfortable but doesn't usually cause any long-term health issues. For women experiencing symptoms, antifungal medication can be taken as a tablet or as a pessary (a tablet inserted into the vagina).

Antifungal cream can also be used around the outside of the vagina to relieve itching and discomfort. Cream shouldn't be inserted into the vagina unless the packaging advises it's safe to do so.

Similarly, it's a good idea to avoid the things we mentioned earlier that disrupt the vaginal environment. These factors can worsen thrush or increase the chances of it coming back.

Managing Symptoms at Home

If you've experienced thrush or BV before, it's possible to manage the symptoms yourself without speaking to a healthcare professional. Remember, this isn't advised if it's your first time experiencing the infection if the infection keeps reoccurring, or if there's a chance your symptoms are due to an STI.

Thrush

Antifungal tablets, pessaries, and creams for thrush can be purchased from a pharmacy. Many women choose to avoid having sex whilst they have thrush, but using lubricant can make it more comfortable if you do.

Bacterial Vaginosis

Antibiotics for BV will require a visit to a healthcare professional, but bacterial vaginosis gel is available to purchase from pharmacies. This lactic acid gel is inserted into the vagina before sleep and may help support the growth of the vagina's good bacteria. It can be used during a BV infection, or when you're at an increased risk of developing BV, such as after sex or a heavy period.

Prevention Strategies for BV and Thrush

Vaginal health is impacted by many of the things we do, including smoking, diet, sexual behaviours, and hygiene.

Smoking is linked to an increased risk of BV and a decrease in the vagina's good bacteria known as Lactobacilli. Stopping smoking can reduce your risk of experiencing these vaginal infections.

We've mentioned the importance of keeping scented hygiene products away from the vagina. This includes soaps, body wash, hair removal creams, shaving gels, moisturisers, and even scented sanitary towels. While some women may use these products with no issues, if you're experiencing regular infections, these items may be making things worse.

Your hygiene habits can also contribute. Wash yourself regularly down there, but it's best to just use water. Always wipe from front to back, and make sure your hands are clean before inserting anything into your vagina.

Some women choose to take regular probiotics for their vaginal health. There's some evidence that probiotics can help support the good bacteria in the vagina, but more research is needed to say for sure.

Understanding the Role of Vaginal pH

The vagina is a self-cleaning organ. This means you don't need to use any cleaning products when washing down there. In fact, douching and washing inside the vagina increases the risk of infection as it disrupts both the pH balance and the balance of good and bad bacteria.

Some women do still choose to wash around their vagina with intimate washes and soaps. It's best to wash with just water, but if you choose to use a product, make sure it's unscented and as mild as possible. Never use these types of products inside the vagina.

Conclusion

While thrush and BV don't usually have serious health consequences, the symptoms overlap with other more serious infections that require treatment. BV and thrush can be passed on during birth, and cause issues during pregnancy, so pregnant women often need treatment.

It's important to seek help from a healthcare professional if you're unsure what's causing your symptoms, if you're pregnant if symptoms keep coming back, or if you have an underlying health condition.