Yeast Infection, BV or UTI?How to Tell the Difference

Something is off. Maybe it itches, maybe it burns, maybe there’s a smell, and you can’t tell if the burn is inside or outside. You’ve had a yeast infection before, or at least you think you did. The pharmacy aisle has a box that says “treats yeast,” and you’re standing in front of it.

Yeast infection (thrush)

The NHS¹ describes white vaginal discharge, often like cottage cheese, that does not usually smell, with itching and irritation around the vulva and vagina, and soreness or stinging during sex or when you pee. It says antifungal treatment should clear it up within 7 to 14 days, and comes as tablets, pessaries or creams. The NHS says to see a GP if you have symptoms of thrush for the first time, or if you’re pregnant. If you’ve been diagnosed before and recognize the symptoms, a pharmacist can recommend treatment. See repeat yeast infections and vulvar itching.

Bacterial vaginosis (BV)

The NHS² says BV brings an unusual discharge with a strong fishy smell, particularly after sex, and a change in color and consistency, such as becoming greyish-white, thin and watery. It says half of women with BV have no symptoms, and that it typically causes no itching or soreness. It’s usually treated with antibiotic tablets, gels or creams from a healthcare provider, and it says to see a GP or sexual health clinic if you suspect it. For BV that comes back more than four times a year, it says an antibiotic gel may be used over several months. See BV and vaginal odor.

Urinary tract infection (UTI)

The NHS³ lists a burning sensation when peeing, needing to pee more often than usual, cloudy or strong-smelling urine, lower tummy pain and fever, and says discolored or smelly urine alone may only mean you need more fluid. It says to drink enough fluids to pass pale urine, to seek urgent care if your symptoms worsen after 48 hours of self-care, and to get emergency help for confusion, drowsiness or difficulty speaking. See how to know if you have a UTI.

Side by side

• Itching and irritation: typical of yeast, not usually BV (the NHS³ says it typically causes no itching or soreness), and not the main feature of a UTI.
• Discharge: thick and white without much smell suggests yeast. Thin, grey-white and fishy suggests BV. Discharge isn’t the main feature of a UTI.
• Burning when you pee: a UTI’s main symptom. Thrush can also sting when you pee, per the NHS¹, so the full pattern matters. A UTI also brings the urge to pee often.
• Smell: fishy points to BV. Strong-smelling urine points to a UTI or dehydration.

Similar symptoms can have different causes, which is a reason not to guess.

What not to do

The NHS² says for BV to wash your genital area with water and plain soap and avoid perfumed products, douches and smoking. See is douching bad for you and vaginal discharge.

The play

Try this: a symptom sort

Before you buy anything, write down: itching (yes or no), discharge color and texture, smell, burning when you pee versus soreness at the vulva, and how often you pee.

Check the three descriptions above. If it doesn’t match one clearly, or it’s your first time, call your clinic.

When to get checked

Don’t wait if

1. Urgent

   Get urgent care for confusion, drowsiness or difficulty speaking with urinary symptoms.

Book an appointment if any of these fit:

• This is your first time with these symptoms
• You’re pregnant and have symptoms
• Symptoms haven’t cleared with treatment
• Symptoms keep coming back
• You have a fever, back or side pain, or pelvic pain
• You’re not sure which one it is

Itching, smell and burning are three different questions. Your symptoms already contain the answers, and a clinician can read them.