BV or UTI? How To Tell the Difference

You have an itch or a pain in your vaginal area. You know it’s abnormal, but you can’t pinpoint what it is. You may be contending with a urinary tract infection (UTI) or bacterial vaginosis (BV) — two conditions that can make you pretty uncomfortable down there. 

“There can be some overlap in symptoms [for both conditions],” explains Dr. Eduardo Hariton, MD, MBA, and a fertility specialist at the Reproductive Science Center of the San Francisco Bay Area.

So, you’re not the only one who may have difficulty distinguishing between the two. According to the Office on Women’s Health, more than half of all women in the United States will have at least one UTI in their lifetime. At the same time, BV is particularly common among women between the ages of 15 and 44 — affecting about 35% of people with a vagina. 

What makes these conditions difficult to discern is that they are both known for changes in vaginal discharge and irritation. 

So, what's the difference between BV and UTI? 

The main difference between BV and a UTI is rooted in how they originate. 

“Normally, the vagina has a mix of ‘good’ and ‘bad’ bacteria, but in BV, the bad bacteria overgrow, causing symptoms,” explains Dr. Hariton. “The exact cause isn’t fully understood, but it is associated with factors like multiple sexual partners, new sexual partners, douching, and a disruption of the normal vaginal flora.” 

Whereas UTIs are triggered by the presence of “bad” bacteria in the urinary tract, not the vagina. 

Dr. Hariton adds: “UTIs are usually caused by Escherichia coli (E. coli) bacteria. They can affect different parts of the urinary system, including the urethra (urethritis), bladder (cystitis), or kidneys (pyelonephritis).” 

Each condition also has trademark symptoms that help distinguish their presence. UTIs are most commonly tied to pee-related symptoms, like painful urination or needing to go to the bathroom more often than normal. According to Dr. Hariton, BV’s signature symptoms include grayish-white vaginal discharge, fishy odor, and vaginal itching or irritation. 

How do doctors diagnose BV vs. UTI? 

While you may want to turn to over-the-counter remedies for your potential BV or UTI, Dr. Hariton suggests visiting your healthcare provider instead. It can be hard to self-diagnose your BV or UTI since their symptoms often overlap. 

An OB/GYN will be able to perform a urinalysis, urine culture, or vaginal swab to help determine what kind of bacteria is present and where. 

Once there, Dr. Hariton recommends keeping the following questions top of mind as a guide for your visit: 

• Could my symptoms be a sign of BV or a UTI?

• What tests do I need to confirm the diagnosis?

• How can I prevent future occurrences of BV or UTIs?

• Are there any lifestyle changes or medications I should consider?

It’s also important to visit a doctor because both conditions are typically treated with oral or topical antibiotics, which require a prescription.

Seeking treatment also helps you get ahead of potential complications, especially if you’re trying to get pregnant, since, as Dr. Hariton explains, “BV has been associated with an increased risk of miscarriage, preterm labor, and low birth weight.”