Trichomoniasis vs. BV (Bacterial Vaginosis): What’s the Difference?

Writer: Jordan Stachel, MS, RDN, CPT

Trichomoniasis vs bacterial vaginosis are two conditions worth understanding and they have several similarities and differences. Understanding the similarities and differences between trichomoniasis and bacterial vaginosis (BV) is important to better identify what condition you may have and to seek treatment.

What Is Trichomoniasis?

Trichomoniasis, or trich, is a sexually transmitted infection (STI) caused by a parasite known as Trichomonas vaginalis. Both men and women can get trichomoniasis, and it can present with or without symptoms.^[1] Some signs and symptoms of trichomoniasis include:

• Foul-smelling discharge or changes to the color of discharge
• Redness or burning of genitals
• Pain during sex or while urinating

It is important to know about trich because it is a fairly common STI and is the most common nonviral STI.^[1] Trich is transmitted through sexual activity and cannot be spread through non-sexual acts like sharing food or drinks.

If you are experiencing symptoms of trich, it is important to get tested, as untreated trich can lead to other health issues. For example, if left untreated, trich can lead to an increased risk of developing human immunodeficiency virus (HIV).^[1]

To diagnose trich, a healthcare provider can complete a physical exam. This may or may not include a pelvic exam for women. A lab test can also be completed, which is when samples are discharged from the genitals and sent to a lab for examination of signs of infection.

Trich is typically treated with antibiotics to kill the parasite that causes the infection.^[1] The condition needs to be treated and won’t go away on its own, so it is important to seek care. The good news is that trich is completely curable with treatment. It also can be prevented by having safe sex and by being tested for STIs for both you and any sexual partners you are with.

What Is Bacterial Vaginosis?

Bacterial vaginosis (BV) is a vaginal infection caused by an overgrowth of bacteria.^[2] BV can only be contracted by women or people who have a vagina. There are increased risks of getting BV, which include^[2]:

• Being pregnant
• Having unprotected sex
• Using certain types of birth control, like an intrauterine device
• Having many sexual partners
• Taking certain antibiotics

It can be helpful to know the symptoms of BV to understand if you should be tested. Some common symptoms of BV include^[2]:

• Changes to the color or smell of discharge
• Itching of the vagina
• A burning sensation during urination

The vagina has a lot of natural bacteria always present. BV can be caused by a change to this natural bacterial environment and if the vagina ends up having more bad bacteria than good.^[2] BV cannot be spread from person to person and is not spread through sexual activity. For this reason, BV is not considered to be an STI. However, because sex can change the bacterial environment of the vagina, sex is considered to be a risk factor for BV.

A healthcare provider typically diagnoses BV by performing a pelvic exam and/or by taking a sample of vaginal discharge.^[2] This sample is then sent for testing to determine if you have BV.

BV is treated using antibiotics. However, there are cases in which BV can go away on its own without the treatment of antibiotics. To be safe, it is always best to consult a qualified healthcare provider if you are having symptoms of BV and are questioning if you need treatment.

To lower the risk of contracting BV, it is advised to avoid douching, make sure that you are not spreading bacteria from the anus to the vagina, have safe sex, test yourself and your sexual partners for STIs, and wear underwear that naturally wicks moisture away.^[2]

How Is Trichomoniasis the Same as BV?

Trich and BV have some overlapping similarities. Some of these include^[1,2]:

• Women can get both trich and BV
• There is an increased risk of getting trich and BV due to having unprotected sex and/or sex with infected individuals
• Both BV and trich can progress without symptoms. If symptoms do appear, there are some overlapping symptoms for each condition, which include changes to discharge, discomfort of the genitals, burning during urination, and discomfort during sexual activity
• A healthcare provider performs a diagnosis through a physical exam for both trich and BV.

How Is Trichomoniasis Different From BV?

While there are some similarities between trich and BV, there are also some important differences. Some of the differences between trich and BV include^[1,2]:

• Trich is considered to be an STI; BV is not considered to be an STI
• Only women can get BV; both men and women can get trich
• A parasite causes trich; a bacteria imbalance causes BV
• Trich is contagious and is transmitted through sexual activity; BV is not contagious and is not transmitted through sexual activity
• Treatment with antibiotics is needed to cure trich; it will not go away on its own. BV may or may not need to be treated with antibiotics; it may go away on its own

How to Know If You Have Trichomoniasis or BV?

To know if you have trich or BV, it is best to be tested by a qualified healthcare provider. They can help you understand how your symptoms or test results indicate one condition versus the other.^[3]

By understanding the key differences, you may also be able to tell if you have BV or trich. For example, if you have not had sexual activity but are experiencing symptoms like pain during urination and changes to discharge, it is unlikely that you have trich, as trich is spread through sexual activity. In this case, even though symptoms are similar, it is more likely that you have BV.

In general, having regular screening done with a qualified healthcare provider is important for optimizing your sexual health and well-being.

Testing for trich should be done if you are having symptoms of trich to get a proper diagnosis and treatment. In addition, testing for trich should be done for people at a higher risk of getting the infection. Testing will also likely be conducted after a round of treatment to help ensure the treatment was successful.^[4] There have been instances in which people need more than one round of treatment to get rid of trich. This may be because their sexual partners are infected and/or if the parasite is resistant to the medication. If this is the case, a healthcare provider may need to switch you to a different antibiotic to eliminate the infection.

There are at-home test kits that you can use as a jumping-off point to see if you have trich. You send a sample to the lab for analysis and wait for results. If the test results are positive, follow-up care will be needed.

Similarly, you can be tested for BV by a healthcare provider, as mentioned above. At-home testing kits are also available to test for BV and may require you to take a sample of the discharge to look for the bacteria that causes BV and/or to test the pH of the vagina.^[5] If the pH test shows high acidity, this could indicate that you have BV. Follow-up care with a healthcare provider is also warranted.

Take Control of Your Sexual Health With Everlywell

Everlywell offers an at-home trich test via a urine sample that screens for the bacteria that causes trich. With an easy-to-use at-home lab test, you will be given everything you need to take this test from the comfort of your own home. From there, if your results are positive, you will be connected with a qualified healthcare provider who can advise you on the next steps. You don’t need to go on this journey alone. Take control of your sexual health today to ensure that you are in tip-top health with Everlywell.