Learn the difference between the symptoms of thrush, bacterial vaginosis (BV) & cystitis & how you can treat them

Since thrush, bacterial vaginosis (BV) and cystitis are all quite common among women and share similar symptoms, it's not always clear which of these three conditions might be affecting the genital area. 

None of these are sexually transmitted infections (STIs), but they may occur at the same time as an STI. So, it's best to visit your GP or sexual health clinic if you’re worried about your symptoms or think you may have an STI.

What is BV?

Many different bacteria and fungi, called flora, occur naturally in the vagina. Having normal vaginal flora helps keep it healthy and protects it against infections. Sometimes, an imbalance in this flora, or an overgrowth of some bacteria, can cause bacterial vaginosis (BV). You might experience some unusual vaginal discharge with a strong, fishy smell but normally it doesn’t cause any soreness or itching. 

What is thrush?

Thrush is usually caused by an overgrowth of the yeast candida albicans which can affect many parts of the body, including the vulva, vagina or penis as well as the mouth and the skin. It is usually harmless but can be uncomfortable and cause itching and irritation around the vagina.

What is cystitis?

Thrush and bacterial vaginosis can affect the vulva and vagina, while cystitis is an inflammation of the bladder. It is usually caused by an infection that involves the bladder and urethra (the tube that connects the bladder to the outside). The main symptoms of cystitis can include pain, burning or stinging when you pee and a need to pee more often or urgently than normal. 

Mild cases of cystitis usually clear up on their own, but sometimes cystitis can progress upwards to the kidneys, increasing your risk of a more serious infection, so it’s important to see your GP if your symptoms don’t improve within three days.

What is causing my unusual vaginal discharge?

If you notice your normal discharge changing in consistency or colour, you may have a vaginal infection. A bad-smelling discharge is also an indication of infection.

Cottage-cheese like discharge:

• Vaginal thrush presents with a thick, white, 'cottage cheese'-like discharge, which doesn’t usually smell 

Watery discharge:

• Bacterial vaginosis causes a watery, thin, greyish, discharge with a fishy smell 

Yellow-green discharge:

• A frothy yellow-green discharge may indicate trichomoniasis, which is an STI 

• Other STIs may also cause a discharge, together with abdominal pain, bleeding, blisters or sores on the vulva

Cystitis doesn't cause unusual vaginal discharge.

How can I treat BV?

Speak to your pharmacist if you are unsure whether your symptoms are BV

If you think you have BV, speak to your GP who may give you a prescription for antibiotics. This is usually a three day course of oral antibiotic  treatment. It’s important to seek treatment if you’re pregnant.

You can also access BV support and treatment with the Boots Online Doctor – Bacterial Vaginosis Treatment, which includes a clinical review within 24 hours.*

Can thrush cause blood in urine?

A yeast infection, like thrush, will not usually cause blood in your urine. However, if you do notice blood in your urine either before, during or after your yeast infection has cleared up, speak to your GP. It’s important that blood in urine is checked by your GP as it could be a sign of something needing further investigation.

Other symptoms of thrush include:

• Stinging and soreness when you pee or during sex

• Irritation and itching around the vagina

• White vaginal discharge, which doesn’t usually smell 

How are thrush symptoms treated?

There are products available over the counter (OTC) which can treat the symptoms of thrush. If you need advice about which treatment is right for you, discuss it with your pharmacist. Products include internal treatments like vaginal creams or pessaries or an oral capsule which can all treat the cause of thrush. There are also creams which provide effective soothing relief of any external symptoms.

There are some circumstances, like if you’re pregnant or breastfeeding where you will need to see your GP about treating thrush. These include if you have thrush for the first time, are under 16 or over 60 years, you’ve had thrush more than four times in 12 months, your symptoms haven’t improved after using an OTC product or you have other symptoms alongside thrush. Your GP will be able to exclude any other causes or an underlying health issue that could be causing your symptoms. Please note, OTC treatments should not be used more than twice in six months without guidance from your doctor or pharmacist.

If you're not certain your symptoms are caused by thrush and think you may have an STI, visit your GP or sexual health clinic to get tested  to ensure you receive the most suitable treatment.

Why do I have vulval irritation?

You may get some redness, irritation and itching with thrush. However, cystitis and BV don't normally cause vulval irritation. 

There are also some STIs that can cause vulval irritation. It’s best to see your GP or get tested at a sexual health clinic if you’re not sure what’s causing your symptoms.

How is cystitis different to BV & thrush?

If you're getting stinging or burning on passing urine, these could be symptoms of cystitis. However, it can also be a symptom of other infections so it's important to discuss your symptoms with your pharmacist or GP if you’re not sure whether you have cystitis. If you do, they can advise the best cystitis treatment for you moving forward.

Cystitis can also cause pain in the lower part of your stomach which can sometimes extend to the sides of your back. If you’re experiencing this, it’s important that you check in with your GP.

What are some effective self-help tips for cystitis treatment?

Luckily, the majority of cases of cystitis are mild and it will clear up on its own in a few days with self-care. There's lots you can do to help relieve your symptoms:

• Drink plenty of water

• Pee frequently 

• Avoid having sex while experiencing symptoms 

• Hold a warm object, like a hot water bottle or a blanket, to your stomach to help to ease the pain

If you're still experiencing symptoms after three days, or your symptoms are severe and include a high or low temperature, pain in the lower tummy or back, confusion, feeling or being sick, you haven’t peed all day or there is blood in your pee you may have a kidney infection so it’s important to speak to a GP urgently. Additionally if you get cystitis frequently or if you’re pregnant or breastfeeding make an appointment with your GP, as you may need a course of antibiotics. Be sure to take the whole course and follow your GP's instructions on whether to take them after or before meals.

You can also access cystitis support and treatment with the Boots Online Doctor – Cystitis Treatment, which includes a clinical review within 24 hours.*

Can you have BV & thrush at the same time?

Yes, it is possible to have bacterial vaginosis and thrush at the same time, although it’s uncommon. If you suspect that you have BV and thrush, your GP can test and treat you for both conditions. First, your symptoms will be reviewed, and a vaginal swab test may be requested to confirm which infection is causing your symptoms.

What can I do to avoid getting BV or thrush?

Since these two infections are closely related to hormonal changes within the body, such as those changes that can happen during your menstrual cycle or during pregnancy, sometimes there is no way of avoiding them. Sexually inactive women can still get these infections, although they seem to be more frequent in women who are sexually active.

• Keep your vagina clean by washing your genital area using water and an emollient rather than soap 

• Avoid using douches, vaginal deodorants or perfumed soap 

• Take showers instead of baths 

• Dry skin thoroughly 

• Choose properly fitting cotton underwear, as tight underwear can increase the chance of infection

 What can I do to avoid getting cystitis?

• Drink plenty of water throughout the day 

• Pee regularly and avoid waiting too long to go to the bathroom. Empty your bladder completely 

• Avoid perfumed soaps and vaginal deodorants and take showers instead of baths 

• Wipe your bottom from front to back after using the bathroom

• Wear cotton underwear and avoid tight-fitting trousers or jeans

What to do next if you are experiencing unusual vaginal discharge

If you’re experiencing unusual vaginal discharge, here are some next steps to consider:

•  Speak to your pharmacist or GP who'll be able to help you differentiate between the three infections and advise on a suitable course of action 

• Visit your GP or a sexual health clinic if you think you may have an STI 

• Drink plenty of water, pee regularly, avoid using perfumed soap to wash your genital area and wear properly fitting cotton underwear to help prevent vaginal and urinary infections

If you’re concerned that your symptoms are not thrush, BV or cystitis, get checked over by your GP to rule out any other cause.

Need tips and advice for managing general health conditions? Head to the Boots women’s health page.

*Access to prescription only medicine is subject to an online consultation with a clinician to access suitability. Charges apply. Subject to availability.

*Subject to availability and clinician approval. Charges apply.