BV vs. Trich: How To Tell the Difference

If you are reading this right now, things may be feeling pretty… uncomfortable down there. Perhaps you are experiencing unusual vaginal discharge that’s accompanied by a noticeable odor and wondering what’s going on and, more importantly, how you can get some relief.

When it comes to unusual vaginal discharge, especially one that’s accompanied by a “fishy” odor, bacterial vaginosis or BV is a likely culprit. After all, it is the #1 most common vaginal infection. But BV isn’t the only vaginal infection to cause these symptoms. In fact, there’s a lot of symptom overlap between BV and a sexually transmitted infection known as Trichomoniasis or Trich. So, how can you distinguish between the two? Keep reading!

Understanding Bacterial Vaginosis (BV) and Trichomoniasis (Trich)

While Bacterial vaginosis and Trichomoniasis are both vaginal infections, they have different root causes. BV is caused by an overgrowth of bad bacteria, while Trich is caused by a parasite. And while unprotected sex can increase your likelihood of contracting BV (which we’ll get into in just a bit), there are other risk factors, too. Trich, however, is a sexually transmitted infection or STI, meaning that it is exclusively passed through sexual contact with an infected partner. 

There is also a difference in who can get these infections. As the name “vaginosis” might imply, only people with a vagina can get a BV infection (though male partners can still have BV-causing bacteria living in their genital area and pass it to female partners during sex), while Trich can impact both women and men.

Now that we’ve done a side-by-side comparison, let’s dive into each infection individually.

What is Bacterial Vaginosis (BV)

Like we said earlier, Bacterial vaginosis is an infection caused by the overgrowth of bad bacteria, typically the bacteria Gardnerella vaginalis. However, just having or being exposed to Garnderella vaginalis does not mean you will get BV. In fact, G. vaginalis is often present in healthy vaginal microbiomes. It only leads to infection when it is allowed to grow rapidly and overtake the microbiome, and overgrowth generally only happens when something has thrown your vaginal pH out of whack.

Your vaginal pH is your vagina’s greatest defense against infection. It is slightly acidic, and it gets this acidity through the presence of certain good bacteria called Lactobacillus. The acidity works to kill bad bacteria before they can multiply and cause infection. If something like poor hygiene or frequent unprotected sex has thrown off your vaginal pH, it can become less acidic than it should be, making it harder to kill bad bacteria and increasing your likelihood of infection.

What is Trichomoniasis (Trich)

Trich is a sexually transmitted infection or STI caused by the parasite Trichomonas vaginalis. Unlike Gardnerella vaginalis, Trichomonas vaginalis is not present in healthy vaginal microbiomes, meaning the presence of this parasite is a sign that you have an infection. 

While BV can sometimes be attributed to things like poor hygiene, Trich is exclusively passed via sexual contact. And this doesn’t just mean vaginal sex! Trich can be passed via oral sex and anal sex, too, and it can impact both men and women.

BV vs Trich Symptoms

Determining the difference between BV and Trich based on symptoms alone can be tricky because, as you will see, they are SO similar. That’s why it’s important to get a diagnosis from a helathcare provider. They will ask about your symptoms but also perform tests like a vaginal swab to see whether a bacteria or parasite is causing your infection.

The symptoms of BV include:

• Thin, gray-ish vaginal discharge
  • This is one of the most common symptoms of BV, experienced by nearly 90% of symptomatic patients¹
• A strong “fishy” vaginal odor that is often worse after sex
• Vaginal itching
• Burning during urination 
• Pain during intercourse

And the symptoms of Trichomoniasis include:

• A greenish-yellow discharge that often looks “frothy”
• Increased volume of vaginal discharge
• Itching, burning, redness, or soreness of the genitals
• Discomfort during intercourse or urination

It’s important to know, too, that both of these infections can be asymptomatic, meaning they don’t have any symptoms. In fact, most people with BV and Trich don’t even know they have it! However, even asymptomatic infections can lead to complications if left untreated, which is why it’s so important to attend regular healthcare appointments that include screening for infections like BV and Trich.

BV vs Trich Treatment

The good news is that BV and Trich are both highly treatable with antibiotics. For Trich, your doctor will likely prescribe metronidazole. The exact dosage may vary depending on your doctor, your symptoms, and the nature of your infection. Sometimes, Trich is treated with a single, stronger dose, and sometimes, it involves several doses over several days. 

Metronidazole can also be used to treat BV, though clindamycin is commonly used, too. 

Even though the treatment is “simple,” that doesn’t mean it isn’t incredibly important! If left untreated, both BV and Trich can lead to infertility issues and, in pregnant women, they increase the risk of preterm birth and low birth weight. And since Trich is an STI, if left ignored, it can turn into an STD, and while STDs can be managed, they can’t ever be 100% cured.

Managing Bacterial Vaginosis and Trichomoniasis

So you know you need to pursue and take antibiotics to treat either BV or Trich. But what other information do you need to manage these infections successfully? 

1) Address any stress

Having a vaginal infection — and especially an STI — can make you feel “dirty” or even shameful, and the symptoms of these infections can cause a lot of discomfort and be incredibly disruptive. Managing any stress around the diagnosis is key, whether that’s through taking daily walks, practicing meditation, or even speaking with a professional — and not just for your mental health! Studies suggest that stress may contribute to BV infections.

2) Abstain from sex (just for a bit!)

Sex with BV or Trich can not only be uncomfortable, but it can prolong your infection and increase your likelihood of reinfection. The last thing you want to do is pass the infection-causing bacteria or parasite to your partner, who then passes it BACK to you. 

For this reason, it’s recommended to abstain from sex for a week after completing antibiotics. So if you have a 3-day course of antibiotics, wait 10 full days from starting that treatment to have sex again. 

3) Incorporate daily probiotics

Antibiotics may be necessary to clear your active infection and prevent further complications… but they aren’t without side effects! 

Antibiotics don’t just kill the bad bacteria in your vagina; they kill ALL the bacteria in your vagina, including the good Lactobacillus we mentioned is responsible for maintaining your vaginal pH. This means that after completing antibiotics, you are vulnerable to secondary infections like vaginal yeast infection. 
Daily probiotic supplements can reduce this risk, especially those like Happy V’s Prebiotic + Probiotic that are doctor-ormulated and contain clinically proven strains of Lactobacillus. By taking a daily probiotic while on antibiotics, you make sure you are replenishing your levels of good bacteria to restore your vaginal microbiome and fight against future infections².

4) Monitor symptoms

Hopefully, your antibitoics will have you feeling better quickly. But if you notice symptoms aren’t improving after a few days or are getting worse, call your doctor to schedule another appointment and see if your unusual vagina discharge is actually the sign of something else. 

Also, if you notice your symptoms have cleared completely, that’s great… but don’t stop taking your antibiotics. It’s important to take all your antibiotics exactly as prescribed to clear the infection completely and prevent antibiotic resistance.

Prevention Measures

You know that saying, “Prevention is the best medicine?” It’s more than just a quippy phrase. It’s an important aspect of vaginal health. So now that we’ve talked about how to clear an active infection let’s talk about how to prevent future ones. 

1) Maintain good hygiene

Part of maintaining a healthy vaginal microbiome and a balanced vaginal pH is practicing good hygiene, including: 

• Not douching
• Washing your vagina using only warm water and mild, unscented soap
• Wiping from front to back after using the bathroom
• Wearing breathable, cotton underwear³

2) Practice safe sex

Using a condom is one of the best and easiest ways to prevent vaginal infections like BV and STIs like Trich. 

Also, as uncomfortable as it can be, it’s important to have open conversations with your sex partner or partners about your past and current health status so they can protect themselves and also help you work toward your own health goals, like ending the cycle recurrent BV.  Again, we know it’s uncomfortable but it gets easier with practice, we promise!

3) Maintain regular health screenings

Remember, while the symptoms of BV and Trich are incredibly similar, most of the time, these infections go entirely unnoticed. That’s why it’s so important to attend annual visits with a healthcare provider like a gynecologist and get regular screenings for vaginal infections, STDs, and STIs. Even if they aren’t causing symptoms now, these infections can lead to bigger issues later.

Final Thoughts

Not feeling confident that you can distinguish between BV and Trich based on symptoms alone? Honestly, you shouldn’t! The only way to determine exactly what is causing your symptoms is to go to the doctor for an exam. The good news is that both of these infections are highly treatable with antibiotics and even preventable with a few key lifestyle changes. The worst thing you can do is ignore the symptoms you are feeling — your health is too important!