Is It a Yeast Infection—or is It BV?

Featured Article, Women's Health
on June 4, 2013
Differences between a yeast infection and bacterial vaginosis.

Ever had a yeast infection? Join the crowd. An estimated 75 percent of women will get one at some point, and some 40 to 45 percent will have two or more. Yeast infections are so common that many women don’t give them a second thought. But there’s a downside to the no-big-deal approach: What some women think is a yeast infection is actually bacterial vaginosis, another type of infection that, left untreated (or treated improperly), can set you up for some serious health problems. An estimated 29 percent of women have developed bacterial vaginosis. Here’s how to tell the difference between these two condition—and zero in on the most effective way to get relief.

The Basics

Yeast Infection
What it is: A fungus called Candida albicans, which lives in the vagina as well as in the mouth and digestive tract and on the skin. Most of the time, it stays in check. But when there’s an overgrowth of the fungus down there, a yeast infection flares up.

Triggers: Be on the alert for a yeast infection when you’re on antibiotics, as they decrease the number of healthy bacteria in the vagina, allowing Candida to thrive. A yeast infection can also occur if you’re pregnant, obese or have diabetes. “Yeast likes three things: moisture, estrogen and sugar,” says Dr. Judith Volkar, of the Center for Specialized Women’s Health at the Cleveland Clinic. In pregnant and obese women, there’s more estrogen available for yeast. High blood sugar levels in women with diabetes also create a yeast-friendly environment. And wearing tight pants and undies made of nylon and other fabrics that don’t breathe can increase the moisture in the (already moist) vagina, giving yeast a field day.

Symptoms: An odorless thick, white, curdy or cheesy discharge; and/or vaginal redness and itching around the entrance to the vagina. It may hurt to have intercourse or urinate.

How it’s diagnosed: With a visual examination of the discharge and other symptoms.  Your gynecologist may take a swab of discharge, mix it with a saline solution and put it under the microscope to check for pseudohyphae–long, branchlike fungus structures.

Treatment: Over-the-counter anti-fungal vaginal creams or suppositories containing miconazole, clotrimazole, tioconazole or butoconazole. Depending upon the medication, use daily for three to seven days. Even if symptoms clear up, finish the medication. If you don’t, symptoms may recur. Another option: an oral prescription pill called fluconazole, that’s taken once. “A lot of my patients prefer this,” says Volkar.

If symptoms are stubborn or recur, see your doctor. You may need to use an OTC anti-fungal cream for up to two weeks, for instance, or take fluconazole weekly for a few weeks. Some women may be advised to use a vaginal cream weekly to prevent a recurrence. The exact regimen will vary depending upon your symptoms and physician.

Bacterial Vaginosis

What it is: BV isn’t an infection—it’s a condition caused by “an overgrowth of less-than-healthy bacteria,” says Volkar. And those bacteria shouldn’t be taken lightly. BV ups the risk of infection after surgeries such as hysterectomy, and it can make you more susceptible to HIV and sexually transmitted diseases such as herpes simplex virus, chlamydia and gonorrhea. If you develop BV during pregnancy, you’re at increased risk for complications such as preterm delivery, says the Centers for Disease Control and Prevention. BV can also raise the risk for pelvic inflammatory disease.

Triggers: Experts aren’t sure exactly what causes BV, but douching may up the likelihood developing it. And, although BV isn’t sexually transmitted, having intercourse with a new sexual partner or having multiple partners may bring it on. “Some women may develop it with one partner and don’t seem to have it with another,” says Volkar.

Symptoms: A thin, grey or white discharge that may have a fishlike odor, especially after intercourse. Woman may experience burning during urination and/or itching around the entrance to the vagina.

How it’s diagnosed: Typically a woman may see the doctor when the yeast infection she has been self-treating doesn’t clear up. The gynecologist will examine a swab of discharge under the microscope, looking for “clue” cells, epithelial cells with fuzzy, crew-cut-like edges that signal BV. Or she may perform a “whiff” test, adding potassium hydroxide solution to a sample of the discharge to produce the fishy smell.

Treatment: With the antibiotics metronidazole (a gel) or clindamycin (a cream), inserted vaginally. Both medications can also be taken orally though this is associated with more side effects. Sometimes, BV clears up on its own. “Some women may have a problem with chronic BV and then it seems to resolve,” says Volkar. On the other hand, some women are dogged by symptoms. In those instances, the recommendation is to treat them with the vaginal gel form of metronidazole twice weekly for up to six months.

Need-to-Know Info

  • Hold off on sex until you finish treatment. Both yeast infections and BV irritate the vagina so sexual intercourse may not be as pleasurable. Plus, if you are using a vaginal cream or gel, the medication can get pushed out of the vagina during intercourse.
  • Vet your laundry products. If you have a yeast infection or BV, don’t use fabric softener when you wash your underwear. “Softener clings to clothing molecules,” says Volkar. And that can further irritate sensitive areas around the entrance to the vagina. Ditto for scented laundry detergent. If you use scented products or softener, give undies a second rinse.
  • Don’t douche. “It really shouldn’t be done,” says Volkar. “It changes the normal flora of the vagina.” And that can encourage abnormal organisms to grow.
  • Try cotton undies. Wearing undies made of unnatural fibers only worsens the itching associated with yeast infections and BV. If you’re prone to yeast infections, stick with breathable cotton.