Bacterial vaginosis and thrush

Also called BV, Vaginal thrush, Candida, Vaginal discharge

Two different causes of discharge, treated differently, and routinely confused. Washing inside the vagina makes both more likely.

What it is

Two of the commonest causes of vaginal discharge, frequently mistaken for each other and for a sexually transmitted infection.

**Bacterial vaginosis** is an imbalance in the normal vaginal bacteria, not an infection caught from anybody. It causes a thin, greyish discharge with a strong fishy smell, often worse after sex. It is treated with antibiotics.

**Thrush** is overgrowth of a yeast that normally lives in the vagina. It causes thick white discharge, intense itching and soreness, and is treated with antifungals.

The distinction matters because the treatments are different and because thrush treatments are sold over the counter, so many women self-treat repeatedly for the wrong thing.

The single most useful piece of advice for both is the same. **The vagina cleans itself.** Washing inside it, douching, using scented soaps, bubble baths, wipes or feminine hygiene products disrupts the normal bacteria and makes both conditions more likely. A great deal of money is spent on products that cause the problem they claim to solve.

BV in pregnancy is associated with preterm birth and should be treated. Recurrent thrush can be a first sign of undiagnosed diabetes.

Anything that does not fit, or does not respond, needs a proper examination and swabs rather than another self-bought treatment.

Signs you might notice

Bacterial vaginosis: thin, watery, grey or white discharge; a strong fishy smell, worse after sex; usually no itching or soreness.

Thrush: thick, white discharge like cottage cheese, usually without a strong smell; intense itching; soreness, redness and swelling; stinging on passing urine or during sex.

See a clinician rather than self-treating for: the first episode; recurrent episodes, meaning four or more a year; pregnancy; blood-stained discharge; pelvic pain or fever; discharge that is green, yellow or offensive; or symptoms that do not settle with treatment.

Urgent: pelvic pain with fever, which may be pelvic inflammatory disease; or bleeding after sex or between periods, which needs assessing.

How it can affect day-to-day life

Shame keeps people out of services and inside the pharmacy aisle, which is where the wrong treatment gets bought.

Sexual health clinics test properly, are free and confidential, and are usually faster than general practice for this.

Recurrent thrush is genuinely miserable and there is a proper treatment pathway, an induction and maintenance regimen over six months, which most people are never offered.

Diabetes should be excluded in recurrent thrush; it is a common route to that diagnosis.

BV recurs in a high proportion of women, and longer suppressive treatment exists.

Neither condition is caused by being unclean, and saying that clearly matters, because the assumption drives exactly the washing behaviour that makes it worse.

Supporting someone well

Do not wash inside the vagina, do not douche, and do not use scented products, wipes or bubble baths. Plain water outside is enough.

Get a proper diagnosis for a first or recurrent episode rather than buying treatment repeatedly.

Use the right treatment for the right condition; antifungals do nothing for BV and antibiotics do nothing for thrush.

Complete the course.

For recurrent thrush, ask about a six-month maintenance regimen and about a diabetes check.

For recurrent BV, ask about longer suppressive treatment.

In pregnancy, get discharge checked rather than self-treating.

Wear cotton underwear, avoid tight synthetic clothing, and change out of damp clothes.

Get anything unusual, bloodstained or painful examined.

Where to get help

A sexual health clinic, free, confidential and usually the best-equipped for testing.

A GP practice, particularly in pregnancy or for recurrent symptoms.

A pharmacist for a straightforward recurrence of previously diagnosed thrush.

Brook for under-25s, and Terrence Higgins Trust for sexual health information.