BV or UTI? How To Tell the Difference

You have an itch or a pain in your vaginal area. Something feels off, and suddenly you’re spiraling through symptom checkers at 2am. It might be a urinary tract infection (UTI) or bacterial vaginosis (BV): two conditions that can make things 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.

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 fairly 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. What fun.

BV vs UTI: What's actually going on down there?

Is it a UTI? BV? Both? Something else? A lot of vaginal and urinary symptoms overlap, even though they’re technically coming from different parts of the body.

Bacterial vaginosis, or BV, is a vaginal condition caused by a shift in your natural bacterial balance. BV is a vaginal microbiome issue. Think of it like your vagina’s bacteria balance getting thrown off. The helpful bacteria get crowded out, and things start to feel different. It’s not an infection traveling up your urinary tract. It’s a shift in the vaginal ecosystem itself. It’s not an STI, and it’s not about being “unclean.” According to the Centers for Disease Control and Prevention, BV happens when protective lactobacilli bacteria are outnumbered by other bacteria.

A urinary tract infection, or UTI, affects your urinary system, including your urethra, bladder, and sometimes your kidneys. UTIs happen when bacteria like E. coli enter the urinary tract and multiply where they shouldn’t. That’s why symptoms usually center around peeing, pressure, or pelvic discomfort, not discharge.

So why the confusion? The vagina and urethra are right next to each other. When one is irritated, it can feel like everything is irritated. The reassuring part is that both BV and UTIs are common and treatable. The American College of Obstetricians and Gynecologists notes that getting diagnosed and treated quickly usually clears symptoms fast and helps prevent complications, especially during pregnancy.

As Dr. Hariton explains, “Normally, the vagina has a mix of ‘good’ and ‘bad’ bacteria, but in BV, the bad bacteria overgrow, causing symptoms. 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.”

UTIs are different. 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).”

You can also have both at the same time (ugh). The vagina and urinary tract sit right next to each other, and pregnancy can make both more sensitive. If your symptoms feel mixed, you’re not being dramatic. It just means testing matters.

BV vs UTI symptoms: How to tell which one you have

If you’re squinting at your symptoms, thinking, this could be either, you’re not wrong. BV and UTIs can feel confusingly similar at first, especially during pregnancy when everything downstairs feels more sensitive. The key is noticing what kind of symptoms you’re having and where they show up.

UTI symptoms: When it's your urinary tract

UTI symptoms tend to revolve around peeing. If your bladder is the main character in this situation, it might be a UTI. Common signs include:

• Painful or burning urination. This is the classic UTI red flag
• Urgency. That sudden gotta go right now feeling
• Frequency. Running to the bathroom every five minutes, but barely peeing
• Cloudy, dark, or bloody urine
• Strong-smelling urine
• Pelvic or lower abdominal pain
• Lower back pain if the kidneys are involved
• Feeling like you can’t fully empty your bladder
• Fever and chills, which can signal a kidney infection require urgent care

One important clue: UTIs usually don't cause vaginal discharge on their own. UTIs affect the urinary system, not the vagina, which is why discharge changes point elsewhere.

BV symptoms: When it's bacterial vaginosis

While UTIs are usually all about painful peeing and running to the bathroom every five minutes, BV has its own calling cards. Think grayish-white discharge, a fishy odor, and vaginal itching or irritation. Common signs include:

• Thin, grayish-white discharge, which is one of the biggest clues
• A fishy smell, especially after sex
• Vaginal itching or irritation
• A burning sensation that feels external rather than deep during urination

Here’s the tricky part: around half of people have no symptoms at all. The Centers for Disease Control and Prevention notes that asymptomatic BV is common, which is why testing matters, especially during pregnancy.

The overlap: Symptoms that could be either

This is where things get muddy. Both BV and UTIs can cause painful urination and pelvic discomfort.

The overlap happens because the vagina and urinary tract sit extremely close together. Irritation in one area can make the whole region feel off, which is why guessing based on symptoms alone can lead you in circles.

This is exactly why a healthcare provider beats Dr. Google every time. A simple urine test or vaginal swab can usually tell the difference fast, and getting the right diagnosis matters, especially if you’re pregnant or being monitored for complications like preeclampsia.

Can you have BV and a UTI at the same time?

Short answer, yes. And it’s not rare.

BV and UTIs affect different systems, but they share risk factors like sex, pregnancy changes, and basic anatomy. Everything down there is close together. When BV shifts the vaginal environment, it can make it easier for bacteria to reach the urethra. A UTI can also cause inflammation that makes your whole pelvic area feel irritated.

If you have both, symptoms can pile on. You might notice discharge and odor along with burning when you pee, urgency, or pelvic pressure. The good news is that both are usually treatable at the same time, often with different antibiotics. The key is testing, so you know exactly what’s going on.

Can a UTI cause BV? (Or can BV cause a UTI?)

They don’t directly cause each other, but they are connected.

A UTI doesn’t turn into BV. However, the antibiotics used to treat a UTI can reduce protective vaginal bacteria, which may make it easier for BV to develop afterward. On the other side, BV-related inflammation can irritate the area around the urethra, making it easier for bacteria to enter the urinary tract.

Add in shared risk factors like sexual activity and the fact that everything down there is very close together, and it makes sense why these two conditions often show up in the same conversation.

Why you might get BV after UTI treatment

Antibiotics are usually the culprit. They treat the bacteria causing your UTI, but they can also lower the healthy bacteria in your vagina. According to a 2025 review published in Biofilms and Microbiomes, antibiotic use can increase the risk of BV because it disrupts the vaginal microbiome’s natural defenses.

So if your symptoms change or new ones pop up after treatment, it’s not random. It’s your body reacting to that shift. That’s when it’s worth checking back in with your provider and getting tested again.

Can BV cause a positive UTI test?

Yes, sometimes. And it’s confusing.

BV can’t infect your bladder, but it can affect a urine test. As a 2025 clinical overview in the National Library of Medicine explains, when BV causes vaginal inflammation, your body releases white blood cells. Those cells, along with vaginal bacteria, can contaminate a urine sample and make it look like a UTI even if your bladder is fine.

A false positive means the test suggests infection, but bacteria may not actually be growing in your bladder. That’s why doctors often wait for a urine culture before prescribing antibiotics. Treating the wrong thing can further disrupt your vaginal bacteria and make symptoms worse.

If discharge, odor, or external irritation are part of the picture, many clinicians will test for BV alongside a urinalysis. BV can’t cause a true UTI, but it can definitely make test results look suspicious.

How to tell if you have BV or UTI: The at-home assessment

First things first. This is not a replacement for seeing a clinician, especially during pregnancy or if preeclampsia is on the radar. This is a quick gut check so you can explain your symptoms clearly.

If you’re sorting through it at home, ask yourself:

• Where is the pain or burning? Deep, internal burning when you pee leans UTI. External, stingy irritation when urine hits the skin leans BV.
• What does the discharge look like? Thin or grayish discharge points to BV. UTIs usually don’t change discharge, but urine may look cloudy or bloody.
• Is there a smell? A fishy odor suggests BV. Strong urine smells are more common with UTIs.
• Are you peeing constantly with urgency? That urgent, barely anything comes out feeling is classic UTI.
• When did symptoms start? Symptoms after sex, a new partner, or douching often align with BV. Sudden urinary symptoms without discharge often point to UTI.

In general, vaginal infections cause discharge and external irritation. UTIs cause bladder-focused symptoms like urgency and internal burning. But if your symptoms are severe, getting worse, include fever, back pain, bleeding, or you’re pregnant, call your provider. That’s not a wait-it-out moment.

If it still feels like it could be either, that’s your cue to test. If getting to a clinic feels tricky, Wisp offers at-home testing through CLIA and CAP-accredited labs, with follow-up care included. They ship discreetly, accept FSA and HSA, and you can get 20% off with code RESCRIPTED.

Getting diagnosed: What your doctor will do

When symptoms overlap, guessing doesn’t help. This is where your provider steps in and actually figures out what’s going on.

For a UTI, they’ll usually start with a urinalysis to check for white blood cells, nitrites, and bacteria. If things aren’t clear, they may order a urine culture to see if bacteria are truly growing and which antibiotic will work best.

For BV, diagnosis typically involves a vaginal swab. Your provider might check vaginal pH, do a whiff test, and look for clue cells under a microscope to confirm it.

While over-the-counter treatments can be tempting, Dr. Hariton recommends seeing your healthcare provider. BV and UTIs can look similar, and self-diagnosing can lead to treating the wrong thing. An OB/GYN can run a urinalysis, urine culture, or vaginal swab to pinpoint the bacteria and where it’s coming from.

Both conditions are usually treated with prescription antibiotics, either oral or topical, so getting the right diagnosis matters.

Questions to ask your doctor about BV or UTI

Walking in with a plan can make the whole thing feel less stressful. Try asking:

• Could my symptoms be a sign of BV or a UTI?
• What tests do I need to confirm the diagnosis?
• Should I also be tested for STIs?
• Could this be something else entirely?
• How do I prevent this from happening again?
• Are there any lifestyle changes or medications I should consider?
• What if my symptoms don’t improve?
• Do I need follow-up testing?

When BV or UTI symptoms mean something else

If symptoms keep coming back or don’t improve, it might not be BV or a UTI at all. Other conditions can feel very similar and need different tests.

STIs like chlamydia, gonorrhea, and trichomoniasis can cause burning, pelvic discomfort, or discharge changes. A 2024 review in the Western Journal of Emergency Medicine found that STI symptoms frequently overlap with BV and UTIs, which is why screening matters when things aren’t clearing up.

Yeast infections are another common mix up, especially after antibiotics. If itching and external burning get worse after treatment, yeast may be the real issue.

If urine tests are negative but urgency and bladder pressure stick around, interstitial cystitis could be involved. It causes UTI-like symptoms without an infection. Vulvodynia or contact dermatitis can also cause burning that feels infection-related, especially if you’ve used scented soaps, wipes, or new products.

If your symptoms don’t match your test results or keep returning, it’s okay to ask for more answers. Persistent discomfort usually means something needs a closer look, not that you’re overreacting.

Trust your gut (and your doctor) when it comes to BV and UTIs

BV and UTIs can feel similar, even though they come from different places. That confusion isn’t on you. It just means getting the right diagnosis matters, because the treatments aren’t the same.

If symptoms don’t improve or don’t match your test results, asking questions or getting a second opinion is smart, not dramatic. And neither BV nor UTIs are a hygiene issue. They’re common. Period.

If you want quick, discreet clarity, Wisp offers at-home testing with CLIA and CAP-accredited labs, follow-up care, free discreet delivery, and FSA and HSA acceptance. You can also get 20% off with code RESCRIPTED.