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Working out whether you’ve got a yeast infection (thrush) or bacterial vaginosis (BV) mostly comes down to two things: is it itchy, and does it smell? Itchy, sore, with thick white discharge and no real odour points to yeast. Thin, greyish discharge with a fishy smell and no itch points to BV.
That covers a lot of cases. But yeast and BV aren’t the only two things going on down there, and the symptoms overlap more than most people realise – so it’s worth knowing the other contenders before you reach for a treatment that won’t work.
Below is the symptom checker – a quick quiz to help you tell the difference between a yeast infection or BV and the conditions that mimic them. There’s an interactive self-check to play with, plus a plain-language run-through of the five things this is most likely to be, and the single best clue for telling them apart.
Yeast or BV, at a glance
The quickest way in is the two classic pictures. Most people land fairly neatly in one of them, so start here and read on if nothing quite fits.
BV is:
- Fishy-smelling discharge
- Watery, grey or thin discharge – no chunks, all looks much the same
- Usually not itchy, sore or inflamed
- May show up after sex with a new person, after your period, or for no reason you can put your finger on
- Can be stubborn and antibiotic-resistant thanks to biofilm – a protective film disruptive bacteria build over the vaginal wall
- Best confirmed with a comprehensive vaginal microbiome test for an accurate diagnosis
- More in our complete guide to treating BV
Yeast is:
- Itchy
- Thick, white, often clumpy discharge
- Doesn’t smell bad at all
- Can get quite raw and sore
- Often turns up after a round of antibiotics, or when you’ve been eating a lot of bread and sugar or drinking a lot of beer
- Very diet-related – yeast tends to start in your gut and work its way down
- Usually straightforward to treat
- More in our guide to yeast infections and thrush
BV or yeast infection quiz – quick symptom checker
Answer what you can. This is a guide to point you in the right direction, not a diagnosis – the only way to know for sure is a test.
It’s not always yeast or BV – three more possibilities
If your symptoms don’t fit either picture, or you’ve treated for yeast or BV and nothing changed, there’s a good chance it’s one of these three. They’re far less talked about, but we see them often in the clinic – usually in people who’ve been round the treatment loop a few times with no luck.
Aerobic vaginitis
- Itchy
- Inflamed and red
- Sore, sometimes burning
- Smells bad – may be fishy, or more like rotten meat, ammonia or faeces
- Usually involves stubborn, often antibiotic-resistant bacteria
- Can be very hard to treat
- Needs accurate diagnosis – it’s easily mistaken for, or found alongside, BV
- More on aerobic vaginitis
Aerobic vaginitis (AV) is the inflamed cousin of BV. Where BV is quiet and mostly just smelly, AV comes with genuine redness, soreness and inflammation, and it’s driven by oxygen-loving bacteria such as E. coli, group B strep and enterococcus rather than the anaerobes behind BV.1 We pull the two apart in our guide to aerobic vaginitis versus BV.
The most severe form has its own name, desquamative inflammatory vaginitis (DIV) – the two sit on the same spectrum rather than being separate conditions.1 Because the bacteria involved are often gut bacteria, persistent AV usually points to something feeding it from elsewhere, which is the part worth chasing down.
Trichomoniasis (trich)
- A sexually transmitted infection caused by a tiny parasite
- Fishy, foul or musty odour
- Greenish or yellow discharge, sometimes frothy
- May be itchy and inflamed
- Can sting when you wee
- Treatable with the right antibiotics – but your partner needs treating too
- More on trichomoniasis
Trich is the odd one out here, because it’s a sexually transmitted infection rather than a microbiome problem. It’s caused by a single-celled parasite, Trichomonas vaginalis, and the classic frothy green-yellow discharge with a foul smell is the typical sign – though plenty of people have only mild symptoms or none at all.2
It’s diagnosed most reliably with a nucleic acid amplification test (NAAT) on a swab or urine sample, and treated with oral antibiotics. Sexual partners need treating at the same time too, or it just bounces back and forth between you.2 This is one to confirm and treat with a doctor or sexual health clinic.
Cytolytic vaginosis (lactobacilli overgrowth)
- Looks a lot like a yeast infection
- Thick white discharge
- Smells normal
- Itchy and sore
- Doesn’t respond to antifungal treatments
- Gets worse in the week or two before your period
- Worse with oestrogen treatments
- Worse in people with histamine intolerance, and may be driven by histamine overload
- Often eases after a baking soda soak or bath
- Seen most in those with blood sugar issues and oestrogen excess, or just after vaginal or oral probiotics
- If you’re otherwise well, it often settles on its own within a few weeks
- More on cytolytic vaginosis
Cytolytic vaginosis (CV) is the great impersonator. It looks and feels like yeast – thick white discharge, itch, soreness – but it’s actually the opposite problem: too many protective Lactobacillus bacteria, which push the vagina so acidic that they start breaking down your own vaginal cells.3
Antifungals don’t touch it, and that’s usually what reveals it isn’t yeast at all – most people treated for yeast who don’t improve turn out to have something else, and CV is a common culprit.3 Because the issue is too much acid rather than too little, raising the pH gently (a baking soda soak is the classic) tends to settle it, which is the reverse of what you’d do for BV.
The single best clue – your vaginal pH
If you only check one thing, make it pH. It splits this whole list cleanly down the middle. BV, aerobic vaginitis and trich all push your vaginal pH up above 4.5, while yeast leaves it normal and cytolytic vaginosis actually drops it lower.4
So a normal or low pH with itch and thick white discharge points towards yeast or CV, and a raised pH points towards BV, AV or trich. Cheap pH strips from the chemist give you a rough read at home – not a diagnosis, but a useful first sort.
What each one is doing to your vaginal environment
Most of these conditions are really stories about your vaginal microbiome – the community of bacteria living in there. A protective vagina is dominated by Lactobacillus species, especially Lactobacillus crispatus, which keep things acidic and crowd out troublemakers.5
Researchers sort the vaginal microbiome into a handful of community state types. A community led by L. crispatus carries the lowest risk of BV and other infections, while a diverse, low-lactobacillus community is the hallmark of BV.5 Yeast is a fungal overgrowth on top of all this; aerobic vaginitis brings in gut-type bacteria; and cytolytic vaginosis is the lactobacilli getting carried away.
In our clinic, this is the lens we use first. Rather than treating each flare as a one-off, we look at what state the microbiome has slipped into and what’s nudging it there – because that’s usually what decides whether a problem clears for good or keeps circling back.
Why guessing goes wrong
Two things trip people up. The first is mixed infections – it’s common to have more than one of these at once, and treating only the obvious one leaves the other quietly running.4 The second is that yeast that won’t clear is very often not yeast at all. Plenty of things mimic a yeast infection – aerobic vaginitis, cytolytic vaginosis or a less common non-albicans yeast wearing a yeast costume.
This is also why tests can disagree with each other, and why a string of failed over-the-counter treatments is itself a clue rather than a dead end. In our experience, the people stuck in a loop of recurrent symptoms are almost always treating the wrong thing, or only half of it.
The other trap is the antibiotic merry-go-round. Repeated broad-spectrum antibiotics knock down your protective bacteria along with the disruptive ones, which is a reliable way to set up the next infection. Breaking that cycle usually matters more than winning any single round.
How each one is actually treated
The headline treatments differ because the causes differ. Yeast responds to antifungals, though stubborn non-albicans strains often don’t, and boric acid is a well-evidenced option there.6–7 BV is usually treated with antibiotics first, while trich needs oral antibiotics for you and your partner.2 Aerobic vaginitis and cytolytic vaginosis need their own targeted approaches – and antifungals do nothing for either.1,3
Natural and functional medicine does its best work in the part conventional treatment often skips: rebuilding the microbiome and removing the driver so the problem stops coming back. The evidence here is real and growing, not wishful thinking.
A vaginal L. crispatus probiotic given after standard BV treatment cut recurrence to 30 per cent versus 45 per cent on placebo at 12 weeks in a randomised trial.8 Boric acid has good evidence across several types of vaginitis, with mycological clearance around 70 per cent for non-albicans yeast.6 And because yeast and aerobic vaginitis are so often fed from the gut, addressing diet and the digestive picture – not just the vagina – is frequently what finally settles things.
This is the approach we take here at My Vagina: confirm what’s actually there, treat it directly, then rebuild the protective microbiome and chase the underlying driver. We don’t do internal or physical exams – for those, a doctor or sexual health clinic is the right call – but the microbiome and root-cause side is squarely our world. If you’d like a steer, our free Killing BV guide is a good start, and you can book an appointment with one of our naturopaths, or ask Aunt Vadge’s Assistant in the bottom-left of your screen.
When to see someone in person
A home symptom check is a great starting point, but some things really do need eyes on them. See a doctor or sexual health clinic if you have a frothy green or yellow discharge, a foul smell, pain when you wee, fever, lower abdominal or pelvic pain, sores or new lumps, or any symptoms while you’re pregnant.
Also worth an in-person visit: symptoms that don’t improve on treatment, anything that keeps coming back, or your first-ever episode when you’re not sure what you’re dealing with. Getting an accurate diagnosis once saves a lot of guessing later.
Frequently asked questions
What’s the difference between BV and a yeast infection?
BV is a bacterial imbalance; a yeast infection is a fungal overgrowth, and they feel different. BV brings thin, greyish discharge and a fishy smell with little or no itch, while yeast brings thick, white, itchy discharge with no real smell. BV also pushes your vaginal pH above 4.5, whereas yeast leaves it normal.4
Is itching or smell the bigger clue?
They’re the two best clues together. Itch with no smell leans yeast or cytolytic vaginosis; smell with no itch leans BV. Both at once raises the chance of aerobic vaginitis, trich, or more than one thing at a time.
Can you have BV and a yeast infection at the same time?
Yes, and it’s more common than people think. Mixed infections are a major reason a single treatment only half works.4 If you’ve treated one and improved a bit but not fully, the other may still be there.
I treated for yeast and it’s no better – why?
Antifungals not working is itself a clue. It often means it was never yeast – cytolytic vaginosis, aerobic vaginitis and non-albicans yeast all get mistaken for ordinary yeast.3 That’s the point to get a proper test rather than repeat the same treatment.
Can I test my pH at home?
You can. Inexpensive pH strips give a rough read, and pH alone sorts a lot: raised (above 4.5) points to BV, AV or trich, while normal or low points to yeast or cytolytic vaginosis.4 It’s a useful sort, not a diagnosis.
Does BV ever go away on its own?
Sometimes it does, but it has a strong habit of coming back, and recurrence is the real problem with BV. Rebuilding a protective, L. crispatus-led microbiome is what makes it stick.5,8
Is trichomoniasis an STI?
Yes. Unlike the others on this list, trich is sexually transmitted, so partners need treating too or it keeps returning.2 It’s worth confirming and treating through a doctor or sexual health clinic.
Why does my infection keep coming back?
Usually because the underlying driver is still there, or the protective microbiome never properly recovered – often after repeated antibiotics. Recurrent symptoms are the cue to stop guessing, test accurately, and treat the root cause.
What’s the best test to know for sure?
For the microbiome conditions, a comprehensive PCR or NGS test maps exactly which bacteria are present and in what amounts, which clears up the AV-versus-BV-versus-yeast confusion. For trich specifically, a NAAT swab is the gold standard.2
What to do next
If your symptoms fit one picture cleanly and it’s your first mild episode, it’s reasonable to treat for that and see. If anything’s confusing, recurrent, or hasn’t shifted with treatment, get a comprehensive vaginal microbiome test so you’re treating what’s actually there.
From there, you can read up on whichever condition fits in our guides to vaginitis, work through the free guide, or book in with us to sort the recurring ones properly. Either way, the aim is the same: clear what’s there now, and rebuild things so it’s far less likely to come back.
This is general information, not a substitute for personalised medical advice.
- Sonthalia S, Aggarwal P, Das S, Sharma P, Sharma R, Singh S. Aerobic vaginitis – An underdiagnosed cause of vaginal discharge – Narrative review. Int J STD AIDS. 2020;31(11):1018–1027.
- Workowski KA, Bachmann LH, Chan PA, et al. Trichomoniasis – Sexually Transmitted Infections Treatment Guidelines, 2021. Centers for Disease Control and Prevention.
- Kraut R, Carvallo FD, Golonka R, et al. Scoping review of cytolytic vaginosis literature. PLoS One. 2023;18(1):e0280954.
- Qi W, Li H, Wang C, et al. Recent Advances in Presentation, Diagnosis and Treatment for Mixed Vaginitis. Front Cell Infect Microbiol. 2021;11:759795.
- Ravel J, Gajer P, Abdo Z, et al. Vaginal microbiome of reproductive-age women. Proc Natl Acad Sci USA. 2011;108(Suppl 1):4680–4687.
- Lærkeholm Müller M, Petersen CD, Saunte DML. Boric Acid for the Treatment of Vaginitis: New Possibilities Using an Old Anti-Infective Agent: A Systematic Review. Dermatol Ther. 2024;2024:2807070.
- Workowski KA, Bachmann LH, Chan PA, et al. Vulvovaginal Candidiasis – Sexually Transmitted Infections Treatment Guidelines, 2021. Centers for Disease Control and Prevention.
- Cohen CR, Wierzbicki MR, French AL, et al. Randomized Trial of Lactin-V to Prevent Recurrence of Bacterial Vaginosis. N Engl J Med. 2020;382(20):1906–1915.
