When you experience vaginal redness, itching, and abnormal discharge, it can be tricky to determine the cause. Knowing whether you have a yeast infection, bacterial vaginosis, or trichomoniasis is critical to properly treat the infection and find quick relief. These conditions all have different causes and require different treatments, so knowing the underlying cause of symptoms is important.
While many of the symptoms of yeast infections, bacterial vaginosis, and trichomoniasis are the same, there are key differences, including how the conditions affect vaginal pH. At-home vaginal pH testing can help you distinguish between the three types of vaginal infections.
What Is a Yeast Infection?
A vaginal yeast infection is caused by an overgrowth of Candida fungi, leading to symptoms such as itching, discharge, and discomfort in the vaginal area.
Yeast infections, also called vaginal candidiasis, is a fungal infection of the vagina and vulva. These common infections are caused by an overgrowth of a microorganism called candida albicans which is a normal part of the microbiome of the vagina and doesn't cause any health issues. Typically, healthy bacteria such as lactobacillus prevent candida from proliferating too much. However, the balance can be thrown off due to issues like antibiotic use, pregnancy, uncontrolled diabetes, or a suppressed immune system.
When candida proliferates in the vagina and vulva, it can cause itching, redness, and soreness. In addition, a yeast infection can cause excessive vaginal discharge that is odorless and may be the consistency of cottage cheese.
Most yeast infections can be treated with over-the-counter anti-fungal treatments.
What Is Bacterial Vaginosis?
Bacterial vaginosis (BV) is caused by an imbalance of bacteria in the vaginal flora, particularly an overgrowth of Gardnerella vaginalis and other anaerobic bacteria.
Bacterial vaginosis (BV) occurs when some normal bacteria in the vagina overgrow. The vagina typically contains a combination of bacteria types, including anaerobes and lactobacilli. When anaerobes overpopulate the vagina, it leads to an imbalance that causes BV.
BV is not considered a sexually transmitted infection, but it is more common among sexually active people. Experts believe sexual intercourse may affect the microbiome in the vagina for some people. BV is not contagious, and you cannot pass it on to sexual partners.
The main symptom of BV is vaginal discharge with a distinct odor. The discharge associated with BV may be off-white, grey, or even greenish and often has a fishy smell. Discharge may increase after sexual intercourse. BV may also cause vaginal irritation or soreness and pain when urinating.
Trichomoniasis, often referred to as "trich," is caused by the protozoan parasite Trichomonas vaginalis. It is a common sexually transmitted infection that can lead to symptoms such as itching, burning, and unusual discharge.
Trichomoniasis is a parasitic infection. It is caused by a one-celled protozoan called Trichomonas vaginalis. It can grow in the vagina, vulva, and cervix. It can infect the urethra, so people of any gender are susceptible to trichomoniasis.
Trichomoniasis is a sexually transmitted infection. It can be passed through any genital contact, including oral, anal, and genital sex. Symptoms of trichomoniasis don't appear until 28 days after exposure. However, you can pass the infection to a partner during that time.
When you have a vaginal trichomoniasis infection, you may notice excessive vaginal discharge that has a strong odor. The discharge associated with trichomoniasis may be thin and frothy and ranges in color from yellow to greenish. It often has a foul, moldy smell. Other symptoms include redness, burning, and itching around the vagina and vulva, pain with urination or sex, and lower abdominal discomfort.
Trichomoniasis can be treated with oral antibiotics.
Urinary Tract Infections
Urinary tract infections (UTIs) can also cause symptoms similar to vaginal infections. A UTI is an infection in your bladder, ureters, urethra, or kidneys. It can cause abdominal pain, painful urination, frequent urination, and blood in the urine. There is no vaginal discharge or discomfort of the vagina and vulva with a UTI.
Urinalysis is a test that checks the physical, chemical, and microscopic properties of urine to help detect health problems.
The texture, color, and odor of vaginal discharge combined with vaginal pH can help you identify the type of vaginal infection.
How to differentiate between different infections?
Look into following physical symptoms to differentiate between different infections.
Discharge - Texture, Color, and Smell
Discharge is a common symptom of many vaginal conditions. You can get clues to the underlying cause by paying attention to the look and smell of your discharge.
The discharge associated with a yeast infection is typically thick, white, and curdy without a strong odor [2]. Keep in mind, however, that you can experience thick white discharge that is not due to a yeast infection, so you will need to look at the other symptoms you have as well.
The discharges typical in BV and trich differ in color, texture and odor. The discharge associated with BV may be off-white, grey, or even greenish and often has a fishy smell [1].
The discharge with trichomoniasis may be thin and frothy and ranges in color from yellow to greenish. It often has a foul, moldy smell. About 70% of people with trich have no symptoms at all, so discharge alone is not a reliable indicator [3].
Other Physical Symptoms
Aside from discharge, there are some other symptoms that are commonly present with yeast infections, BV, and trich. Comparing symptoms can be helpful in determining whether it's a trichomoniasis, BV or yeast infection. All three may present with itching, soreness, and redness, although these symptoms are less common with BV. Trich sometimes causes pain with urination, which is not a symptom of BV or a yeast infection.
Yeast Infection vs UTI
Symptoms can help you tell the difference between a UTI and a yeast infection. If you experience no discharge but a burning sensation with urination, you may have a urinary tract infection or UTI. Burning upon urination can occur with either yeast infection or UTI, but accompanying discharge is usually associated with a yeast infection.
UTI vs BV
If you're unsure if you have BV or a UTI, consider your symptoms. Both can cause painful urination. However, only BV causes vaginal discharge; discharge with a strong, foul odor, particularly after sex, is a strong indicator of BV.
BV vs Yeast Infection
When comparing bacterial vaginosis and a yeast infection, look for texture and odor of vaginal discharge. An odorless, cottage cheese-like discharge is associated with a yeast infection. On the other hand, discharge with a strong foul odor, particularly after sex, is a strong indicator of BV.
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Diagnosing Vaginal Infections with Vaginal pH
Many of the symptoms of yeast infections, bacterial vaginosis, and trichomoniasis are similar. This can make it difficult to know which condition is affecting you. One way to determine the most likely cause of your discomfort is by testing the pH levels in your vagina, as well as assessing your other symptoms.
BV vs. Trichomoniasis
Typical pH levels in the vagina are between 3.8 to 4.5. Both BV and trichomoniasis lead to an increase in vaginal pH. If testing shows a pH greater than 4.5 combined with fishy-smelling discharge, you likely have BV. A vaginal pH higher than 4.7 combined with frothy, moldy-smelling discharge is likely to be caused by trichomoniasis [4, 5].
BV vs Yeast infection vs Trich
Yeast infections do not cause a change in pH. If your vaginal pH levels are in the normal range, symptoms such as excessive discharge and itching or discomfort are likely a sign of a yeast infection. At-home pH tests can work like an over-the-counter or OTC yeast infection test and spare you a trip to a doctor.
How characteristics of vaginal discharge (texture, color, odor, and pH) and physical symptoms relate to different vaginal infections such as vaginal yeast infections (thrush), bacterial vaginosis (BV), trichomoniasis (trich), and urinary tract infections (UTI).
At-Home pH Testing
Measuring vaginal pH may sound intimidating, but it can easily be performed with a simple at-home test. The Vaginox test kit offers a quick, reliable, and cost-effective way to determine vaginal pH level discreetly from the comfort of your home. The individually packaged vaginal pH test strips provide reliable vaginal pH data. This all-in-one test kit allows you to assess vaginal pH balance as it relates to infections, such as vaginal yeast infections, trichomoniasis, or bacterial vaginosis.
If you are experiencing discomfort and unusual discharge and you have a normal vaginal pH, you can take an at-home yeast infection test to confirm and treat the infection accordingly. Having an elevated pH is a strong signal that you have a bacterial or parasitical infection and should seek prompt medical care for a diagnosis and treatment.
[5] A. M. Powell, P. Nyirjesy, "Recurrent vulvovaginitis" Best Pract Res Clin Obstet Gynaecol. 2014 Oct;28(7):967-76.
About the Author
Nicole Valentine
Nicole Valentine is a blog and article writer with experience writing about a huge array of topics. She is passionate about sustainability, healthy living, and mindful parenting.
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