A yeast infection (vaginal thrush) usually causes intense itching and soreness with thick, white, cottage cheese-like discharge and little smell. Bacterial vaginosis (BV) usually causes thin, grey or white discharge with a strong fishy smell, often worse after sex, and little itching. They need different treatments, so getting it right matters.
Side-by-side comparison
| Yeast infection (thrush) | Bacterial vaginosis | |
|---|---|---|
| Cause | Overgrowth of Candida yeast | Imbalance of vaginal bacteria |
| Discharge | Thick, white, lumpy | Thin, grey or white, watery |
| Smell | Little or none | Fishy, especially after sex |
| Itching/soreness | Common and intense | Uncommon |
| Vaginal pH | Normal (4.5 or below) | Raised (above 4.5) |
| Treatment | Antifungal (clotrimazole cream/pessary, fluconazole tablet) | Antibiotics (metronidazole or clindamycin) |
Common triggers
Thrush
- Antibiotics
- Pregnancy
- Uncontrolled diabetes
- Weakened immunity
BV
- Douching and perfumed products
- New or multiple sexual partners
- Smoking
- Copper IUD in some women
Treatment tips
- Healthcare providers can often provide thrush treatment; pregnant women should use creams or pessaries, not oral fluconazole, and see a health worker
- BV needs antibiotics from a healthcare provider; avoid alcohol while taking metronidazole if advised
- Male partners don’t usually need treatment for either, though thrush can occasionally affect them
When to see a nurse or healthcare provider
- First time with symptoms
- Pregnant
- Symptoms return more than twice in 6 months
- Treatment doesn’t work
- Possible STI exposure, pelvic pain, fever, or unusual bleeding
- Under 16 or over 60
Prevention
- Avoid douching, perfumed soaps and vaginal “cleansers”
- Wear cotton underwear
- Change out of wet swimwear or gym clothes promptly
- Use condoms with new partners
Frequently asked questions
Is BV an STI?
No, but it’s linked to sexual activity and increases the risk of catching some STIs.
Can I have both at once?
Yes, it’s possible. Testing can confirm.
Related reading: Vaginal discharge colours · Chlamydia guide
Checked against NHS guidance on thrush and bacterial vaginosis. Updated 5 November 2026.
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