Bacterial Vaginosis vs Candidal Vulvovaginitis
Bacterial Vaginosis and Candidal Vulvovaginitis are easy to mix up on the boards. Here's a side-by-side comparison — presentation, workup, imaging, and first-line treatment — drawn from our full outlines.
Bacterial Vaginosis vs Candidal Vulvovaginitis at a glance
- Bacterial Vaginosis: Dysbiosis of vaginal flora — loss of lactobacilli with overgrowth of anaerobes; thin gray discharge with fishy odor.
- Candidal Vulvovaginitis: Yeast infection of the vulva/vagina — thick white discharge, intense pruritus, normal pH.
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Side-by-side comparison
| Feature | Bacterial Vaginosis | Candidal Vulvovaginitis |
|---|---|---|
| At a glance | Dysbiosis of vaginal flora — loss of lactobacilli with overgrowth of anaerobes; thin gray discharge with fishy odor. | Yeast infection of the vulva/vagina — thick white discharge, intense pruritus, normal pH. |
| Classic presentation | Reproductive-age woman with thin gray discharge, fishy odor after intercourse, vaginal pH >4.5, clue cells on wet mount, positive whiff test.; Thin,… | Woman after antibiotic use with severe vulvar itching, vulvar erythema, thick curd-like discharge, normal pH, and yeast/pseudohyphae on KOH prep.; Intense… |
| Workup / key labs | Amsel criteria (3 of 4): (1) thin homogeneous gray-white discharge, (2) vaginal pH >4.5, (3) positive whiff test with KOH, (4) clue cells on saline wet mount.… | Vaginal pH normal (<4.5) — important distinguishing feature; 10% KOH wet mount: budding yeast, pseudohyphae (C. albicans) or budding yeast without… |
| First-line treatment | Metronidazole 500 mg PO BID × 7 days; Metronidazole 0.75% vaginal gel 5 g intravaginally daily × 5 days; Clindamycin 2% vaginal cream 5 g intravaginally at… | Uncomplicated: fluconazole 150 mg PO × 1 dose; Topical azole alternatives × 1-7 days: clotrimazole, miconazole, terconazole, tioconazole (available OTC);… |
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