BV vs. Trich: What’s the Difference and Why It Matters

Let’s be real: when something’s off down there, whether it’s new vaginal discharge, irritation, or a certain fishy smell, you want answers—fast. Two of the most common causes of those symptoms? Bacterial vaginosis (BV) and trichomoniasis (trich).

They’re both vaginal infections, and their symptoms can seriously overlap. But here’s the catch: BV and trich have very different root causes, treatment options, and long-term health implications. In fact, one is an STI and the other isn’t!

Let’s break down the key differences, so you can feel more confident talking to your healthcare provider, getting the right care, and protecting your sexual health, without the stress spiral.

This post is for informational purposes only and does not constitute medical advice. See full disclaimer below.

What Is Bacterial Vaginosis?

Bacterial vaginosis (BV) is the most common vaginal infection—and by a long shot! In fact, the Centers for Disease Control and Prevention (CDC) estimates that 21 million women every year get diagnosed with BV in the United States alone¹.

BV isn’t technically an STI (sexually transmitted infection), but it is more likely to show up in people who are sexually active or who have frequent changes in sex partners².

What causes it?

BV is caused by an overgrowth of bacteria, especially the bacteria Gardnerella vaginalis³. On its own, G. vaginalis is not problematic. In fact, even balanced microbiomes contain G. vaginalis. However, when it starts to multiply and overtake the vaginal flora, it can replace helpful Lactobacilli bacteria. This is when you will notice symptoms.

Symptoms of BV:

Believe it or not, BV isn’t always symptomatic⁴. In fact, it’s estimated that over half of women who have an active BV infection don’t have any symptoms at all. Those women who do experience symptoms often experience:

• Thin, gray or white vaginal discharge⁵
• A strong fishy odor, often more noticeable after sexual intercourse⁶
• Mild vaginal itching or irritation
• Burning during urination
• Pain during sex
• No symptoms at all (but it can still cause problems if left untreated)

BV is diagnosed with a vaginal swab, pH test, and/or microscopic analysis by a healthcare provider. It’s typically treated with oral antibiotics like metronidazole or clindamycin⁷.

What Is Trichomoniasis?

Unlike BV, Trichomoniasis (aka trich) is an STI caused by a microscopic parasite called Trichomonas vaginalis⁸. Trich is spread exclusively through through sexual contact, including vaginal, oral sex, and anal sex.

Trich can affect anyone, regardless of gender⁹. It’s one of the most common curable STIs, according to the CDC, but many people don’t know they have it because symptoms are often mild or totally absent¹⁰.

This is why routine STI/STD testing is so important if you’re sexually active. If left untreated, even asymptomatic trich can lead to more serious health issues down the road, including pelvic inflammatory disease and complications during pregnancy.

Symptoms of trich¹¹:

• Frothy, yellow-green vaginal discharge
• Musty or unpleasant odor
• Redness, soreness, or itching around the vulva
• Burning or pain during urination
• Discomfort during sexual contact
• Increased discharge volume
• Or no symptoms at all

Trich is usually treated with a single dose or short course of metronidazole or tinidazole¹². Partner treatment is essential to prevent recurrence.

BV vs. Trich: Key Differences

What About Yeast Infections?

A yeast infection (aka candidiasis) happens when there’s an overgrowth of the fungus Candida, most often Candida albicans¹³. It often shows up after antibiotic use or during times of hormonal change, like before menstruation or during pregnancy.

Symptoms of a yeast infection include:

• Thick, white, “cottage cheese-like” vaginal discharge¹⁴
• Itching, burning, or redness around the vulva
• Swelling or discomfort during sex or urination
• No strong odor

Why You Shouldn’t Self-Diagnose

Here’s the tricky part: both BV and trich can show up with very similar vaginal symptoms, and both can be totally asymptomatic. That’s why it’s important to get a proper diagnosis from a healthcare provider.

Untreated infections, whether bacterial vaginosis, trichomoniasis, or candidiasis, can increase your risk of STIs, lead to complications like pelvic inflammatory disease, and in pregnancy, raise the chances of preterm delivery and low birth weight¹⁵.

Bottom line: don’t guess. Get a swab and the right treatment.

Treatment and Recovery Tips

• Take your antibiotics correctly: Finish every round of antibiotics exactly as prescribed, even if uncomfortable symptoms like vaginal discharge clear up early. This prevents recurrence and antibiotic resistance.
• Treat your partner(s): If you’re being treated for trich, your sexual partners need treatment too, even if they don’t have symptoms. This helps prevent reinfection.
• Abstain from sex: To avoid passing or reintroducing bacteria or parasites, hold off on sex until a week after you have completed all your meds.
• Rebuild your microbiome: Taking a daily probiotic designed for women’s health, such as Happy V’s Prebiotic + Probiotic, may help support your vaginal microbiome after antibiotics.
• Keep an eye on symptoms: If things don’t improve within a few days or get worse, check in with your healthcare provider.

Prevention Measures

• Skip the douching. It disrupts your natural pH because your vagina is self-cleaning¹⁶!
• Wear breathable, cotton underwear
• Wash with warm water and mild, unscented soap
• Use condoms or other barrier protection during sexual intercourse
• Get regular STI screenings and talk to your provider about recurring infections
• Consider daily probiotics for added support, especially those doctor-formulated for vaginal health¹⁷

Final Thoughts

BV, trichomoniasis, and yeast infections may share some symptoms, but they’re very different under the microscope and require different care. Whether you’re noticing changes in vaginal fluid, dealing with discomfort, or just staying proactive, don’t wait to reach out to your healthcare provider.

With the right support, knowledge, and treatment options, you can feel better faster and stay in tune with your body for the long run.

Keep the Conversation Going

• Visit our blog for more on BV treatment options and women’s health tips.
• Join our private Happy V Facebook group to hear from others who’ve been there.
• Explore supplements designed to support your vaginal health journey.

Disclaimer: This blog is for informational and educational purposes only and is not intended to diagnose, treat, cure, or prevent any disease. Statements about supplements have not been evaluated by the Food and Drug Administration. For more information about vaginal infections, visit the CDC or speak to a licensed healthcare provider.