Thrush, cystitis or BV?

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 the cause of any irritation, burning or discomfort in 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 doctor or a sexual health clinic if you’re worried about your symptoms or think you may have an STI. 

What are thrush, BV & cystitis?

Thrush and bacterial vaginosis can affect the vulva and vagina, while cystitis is an inflammation of the bladder. 

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 BV. 

Thrush is caused by an overgrowth of the yeast candida which can affect many parts of the body, including the vulva, vagina or penis as well as the mouth and the skin. 

Cystitis is an inflammation of the bladder, usually caused by an infection that involves the bladder and urethra (the tube that connects the bladder to the outside). Mild cases of cystitis usually clear up on their own, but sometimes cystitis can progress upwards to the kidneys, and can potentially cause a more serious infection. So it’s important to see your doctor if your symptoms don’t improve.

What is causing my discharge?

Cystitis doesn't cause 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.

  • BV causes a watery, thin, greyish discharge with a fishy smell
  • Thrush presents with a thick, white, 'cottage cheese'-like discharge, which doesn’t usually smell
  • A frothy yellow-green discharge indicates trichomoniasis, which is an STI
  • Other STIs may also cause a discharge, together with abdominal pain, bleeding, blisters or sores on the vulva

Why do I have vulval irritation?

Cystitis doesn't normally cause vulval irritation. However you may get some redness, irritation and itching with thrush. BV can cause some irritation but does not usually cause itching. 

There are some STIs that can cause vulval irritation.

It is best to see your Doctor or get tested at a sexual health clinic if you are not sure what’s causing your symptoms. 

How is cystitis different to BV & thrush?

If you're getting stinging or burning on passing urine, this could be a sign of cystitis. However, it can be a symptom of other infections, so it's important to discuss your symptoms with your pharmacist or Doctor if you’re not sure whether you have cystitis. 

Cystitis can also cause pain over the lower part of your stomach which can sometimes extend to the sides of your back. 

How can I treat BV?

Unless you have symptoms, there's generally no need to treat BV. Speak to your pharmacist who may be able to give you advice about what's available over the counter. 

If this first treatment is unsuccessful, you may need to see your Doctor who may give you a prescription for antibiotics. These come as tablets, vaginal creams or gels. Some are taken as a one-time only dose, while others need to be taken for a few days.

How are thrush symptoms treated?

It's usually easy to treat thrush with anti-fungal vaginal creams or pessaries. If you've had thrush before, discuss it with your pharmacist who will advise you on what treatments are available over the counter. There are some circumstances which you will need to see your Doctor about treating thrush, such as if it's recurring, doesn't improve or comes alongside other symptoms. Your Doctor will be able to exclude any other causes that could be giving you similar symptoms.

If you're not certain your symptoms are caused by thrush and think you may have an STI, visit a sexual health clinic where you'll be able to have tests to ensure you receive the most suitable treatment.

What's the treatment for cystitis?

In the majority of cases of mild cystitis, 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. This may help to flush out the infection
  • Pee frequently
  • Avoid having sex while experiencing symptoms
  • Holding a warm object, like a hot water bottle or a blanket, to your stomach may help to ease the pain

If you're still experiencing symptoms, make an appointment with your Doctor, as you may need a course of antibiotics. Be sure to take the whole course and follow your Doctor's instructions on whether to take them after or before meals.

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 or have a new partner.

  • Wash 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 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

Next steps

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