Healthcare provider with urine sample to test for BV vs. UTI

BV vs. UTI: the differences explained

Written on March 19, 2023 by Amy Harris, MS, RN, CNM. To give you technically accurate, evidence-based information, content published on the Everlywell blog is reviewed by credentialed professionals with expertise in medical and bioscience fields.


Table of contents


Bacterial vaginosis (BV) and urinary tract infections (UTIs) are some of the most common (and annoying) bacterial infections. Only people with a vagina can have BV, while UTIs plague both men and women. For both infections, however, people with female anatomy are more likely to have multiple UTIs and BV infections over their lifetime.

Learning about the similarities and differences between these two infections can help you detect symptoms for quicker, more effective treatment. Everlywell, with convenient at-home testing options and virtual healthcare, is your partner in the quest to keep UTIs and BV infections from ruining your day (and your health).

At a glance: BV vs. UTI

Many of us know when something just doesn’t feel right “down there,” but figuring out whether it is BV or a UTI is less cut-and-dry. This chart can help you understand the basics of these two common infections.

Bacterial Vaginosis (BV) Urinary Tract Infection (UTI)
Infection of the vagina Yes No
Infection of the urethra and bladder No Yes
Caused by bacteria that normally live in the body Yes Yes
Can be caused by sexual activity Yes Yes
Is sexually transmitted No (except between female-female partners) [1] No
Treated with antibiotics Yes Yes
Can be recurrent Yes Yes
Infects men and women No Yes
Prevention strategies reduce repeat infections Yes Yes
Common in pregnancy Yes Yes
Common during perimenopause and menopause Yes Yes
Can be treated by telehealth Yes Yes

Bacteria cause both BV and UTIs

Part of being a human being is sharing your body with a broad diversity of invisible-to-the-naked-eye bacteria. You have a community (called a microbiome) of bacteria, fungi, and viruses that live in your gut, your vagina (if you have one), and your bladder [2].

Both BV and UTIs are caused by the wrong kind of bacteria moving into a new home, a different part of your body. An overgrowth of the wrong kind of bacteria in the vagina causes an inflammatory response. Bacterial vaginosis (BV) is the most common cause of abnormal vaginal discharge in reproductive-age females. Most people with BV notice [3]:

  • Increased vaginal discharge, usually thin and grey, white, or green
  • A fishy, foul-smelling odor that can be stronger after penile-vaginal sex
  • Burning when peeing
  • Vaginal itching or irritation

Bacteria (most commonly E. coli) from your gut cause UTIs when they are transported from your anus to your urethra (the opening to the urinary tract) and up to your bladder (where your urine is stored) [4]. The symptoms of a UTI in both genders are [5]:

  • Pain or burning when peeing
  • Frequent trips to pee
  • Pelvic or belly pain (more commonly in women)
  • Foul-smelling urine
  • Cloudy urine
  • Pink, red, or cola-colored urine (a sign of blood in your urine)
  • Fever, nausea (when your kidneys get infected)
  • Side or back pain (when the infection spreads to your kidneys)

You’ll notice in looking through these symptom lists that there is some overlap. Both UTIs and BV can cause pelvic or abdominal pain, burning when peeing, and a change in the smell you might notice when making trips to the toilet. That’s why it can be helpful to talk through your symptoms with a healthcare provider, like those that can be accessed through Virtual Care Visits.

Similarity to STI symptoms

While neither BV nor UTI is sexually transmitted, people who are sexually active are more likely to have BV or UTIs [3-6]. Because some of the symptoms overlap with those of common STIs, testing for STIs is a necessary part of figuring out what is causing your symptoms and helping you feel better faster [6].

Abnormal vaginal discharge can result from certain sexually transmitted infections (STIs), including chlamydia, gonorrhea, and trichomoniasis [6,7]. Infections cause by trichomonas, the herpes virus, gonorrhea, and chlamydia can also cause pain or burning when peeing. Everlywell’s convenient and discrete at-home STI screening tests for trichomoniasis, gonorrhea, and chlamydia can bring you peace of mind quickly and easily.

Recurrence of BV and UTIs

Once you have the right diagnosis, the good news is that antibiotics can easily treat UTIs and BV [2,3]. But, even with quick treatment, recurrence is common for both UTIs and BV. Healthcare providers classify UTIs as recurrent if you have more than two UTIs in six months or three to four diagnosed UTIs in one year [4]. As many as 4 in 10 women who get a UTI will get at least one more within six months [8].

More women experience a repeat BV infection than a repeat UTI–half of all women diagnosed with BV will have a second infection within one year [9]. Healthcare providers diagnose recurrent BV if you have three or more confirmed symptomatic BV episodes in one year [10].

Treat BV and UTI to avoid more serious health problems

If not treated correctly and immediately, both BV and UTIs are more likely to come back for a repeat visit. BV will sometimes go away without treatment and many people wonder whether you can get rid BV or UTIs naturally [1]. Untreated infections can cause more serious health consequences.

Getting treated for BV may reduce your risk for some STDs [6]. BV is usually treated either by taking antibiotics by mouth or with a vaginal cream [3]. Untreated BV can lead to a serious infection of your pelvis and cause complications if you have pelvic surgery or a procedure while you have BV [3]. BV can also increase your risk for infertility and preterm labor if you are pregnant.

UTI symptoms can also come and go, making some people think they go away on their own. Healthcare providers recommend taking antibiotics to treat UTIs to avoid more serious health consequences such as [4]:

  • A kidney infection (pyelonephritis)
  • Preterm labor or delivering a low birthweight infant if you are pregnant and have a UTI
  • A narrowed urethra (in men) after repeated UTIs
  • Sepsis (a life-threatening infection)

If you have symptoms of BV or a UTI, you should be checked and treated. It is important to take all of the medicine prescribed to you, even if your symptoms go away, to reduce your chances of a recurrent UTI or BV infection. Telehealth practitioners can provide you with helpful information about your symptoms, a care plan, and prevention strategies. Consider trying Everlywell's option for UTI treatment online.

Trichomoniasis vs. BV (bacterial vaginosis): what’s the difference?

How can I get rid of a UTI in 24 hours without medication?

Things to avoid when you have a UTI: what you need to know


References

  1. STD facts: Bacterial vaginosis. Centers for Disease Control and Prevention. URL. Updated January 5, 2022. Accessed March 12, 2023.
  2. Chen X, Lu Y, Chen T, Li R. The female vaginal microbiome in health and bacterial vaginosis. Front Cell Infect Microbiol. 2021;11:631972. doi:10.3389/fcimb.2021.631972. URL.
  3. Bacterial vaginosis. Mayo Clinic. URL. Accessed March 12, 2023.
  4. Urinary tract infections (UTIs). Mayo Clinic. URL. Updated September 14, 2022. Accessed March 12, 2023.
  5. Urinary tract infections (UTIs). Centers for Disease Control and Prevention. URL. Updated October 6, 2021. March 12, 2023.
  6. Shapiro T, Dalton M, Hammock J, Lavery R, Matjucha J, Salo DF. The prevalence of urinary tract infections and sexually transmitted disease in women with symptoms of a simple urinary tract infection stratified by low colony count criteria. Acad Emerg Med. 2005;12(1):38-44. doi:10.1197/j.aem.2004.08.051. URL.
  7. Trichomoniasis. Centers for Disease Control and Prevention. URL. Accessed March 12, 2023.
  8. Urinary tract infections. National Kidney Foundation. URL. Published 2010. Accessed March 6, 2023.
  9. Faught BM, Reyes S. Characterization and Treatment of Recurrent Bacterial Vaginosis. J Womens Health (Larchmt). 2019;28(9):1218-1226. doi:10.1089/jwh.2018.7383. URL.
  10. Vaginitis in Nonpregnant Patients: ACOG Practice Bulletin, Number 215. Obstet Gynecol. 2020;135(1):e1-e17. doi:10.1097/AOG.0000000000003604. URL.
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