BV vs Chlamydia -
Understanding the Key Differences

Written by Kathleen Morrison
Medically Reviewed by Andrea Sleeth WHNP-BC, MSCP

Key takeaways:

• BV is caused by an imbalance of vaginal bacteria, while chlamydia is a sexually transmitted infection caused by bacteria.
• The two conditions can share symptoms like unusual discharge or irritation, which is why they often get confused.
• BV cannot turn into chlamydia, but having BV can make it easier to pick up an STI like chlamydia.
• Chlamydia often has no early symptoms, making regular testing essential even when everything feels normal.
• The only way to know what is really going on is through proper testing, which helps ensure you get the right treatment fast.

Unusual discharge, itching, and general discomfort down there can have a few different causes—and bacterial vaginosis (BV) and chlamydia are two that often get suspected, as well as mixed up.

BV happens when the natural balance of bacteria in your vagina shifts, while chlamydia is a sexually transmitted infection caused by the bacteria Chlamydia trachomatis. BV can’t turn into chlamydia (and chlamydia also can't turn into BV), but the two conditions can show up together.

And unfortunately, having BV can actually make it easier to pick up a sexually transmitted infection (STI) like chlamydia because the vagina’s usual defenses are a little out of whack. Both conditions can cause similar symptoms—think unusual discharge, odor, or irritation—which is why proper testing is the only way to know what’s going on.

A quick breakdown of BV vs. Chlamydia

When it comes to BV and chlamydia infections, the two conditions can sometimes look a little alike on the surface, but they’re actually super different. Here’s a clear breakdown to help you spot the differences and understand what each one means for your sexual health.

Cause:

• Bacterial vaginosis (BV): imbalance of natural vaginal bacteria
• Chlamydia: bacterial STI caused by Chlamydia trachomatis

Early signs:

• BV: thin, watery discharge; a fishy odor which is sometimes all you’ll notice
• Chlamydia: often no symptoms at first

Key symptoms:

• BV: thin gray or white discharge, strong fishy odor (often worse after sex), itching or burning
• Chlamydia: clear, whitish, or yellowish discharge, pelvic pain, bleeding between periods, pain during sex

Diagnosis:

• BV: pH test, microscopy, bacterial culture
• Chlamydia: STI testing via urine or swab

Treatment:

• BV: antibiotics such as metronidazole or clindamycin
• Chlamydia: antibiotics like azithromycin or doxycycline

Transmission:

• BV: not an STI (though sexual activity can increase risk)
• Chlamydia: sexually transmitted infection

Complications if untreated:

• BV: higher risk of STIs, potential pregnancy complications
• Chlamydia: pelvic inflammatory disease, infertility, ectopic pregnancy
  

What is Bacterial Vaginosis (BV)?

Bacterial vaginosis happens when the normal balance of bacteria in your vagina gets thrown off its usual course.

Think of your vaginal ecosystem as a tiny, perfectly tuned garden—BV is what happens when some of the plants start crowding out the flowers you actually want.

It’s not technically an STI, though sexual activity can trigger it. BV is usually caused by an overgrowth of certain naturally occurring bacteria, especially Gardnerella vaginalis. When these bacteria multiply too fast, they push out the good lactobacilli that normally keep your pH in check, which can lead to that classic thin, grayish discharge with a noticeable fishy odor.

Millions of women experience BV each year, and while it’s common, the symptoms can still feel super uncomfortable and frustrating—so knowing what’s going on is important (so you can start feeling better fast).

What is Chlamydia?

Chlamydia is a sneaky bacterial STI caused by Chlamydia trachomatis.

Unlike BV, it’s an infection you catch from an infected partner, and it can show up in the cervix, urethra, rectum, or even your throat.

The tricky part? Many people don’t notice any symptoms at all (at least in the beginning), which is why it’s so common and so commonly ignored.

When symptoms do appear, you might notice unusual discharge, pelvic pain, or bleeding between periods, but it’s really impossible to self-diagnose. Left untreated, chlamydia can cause serious complications like pelvic inflammatory disease and infertility, which is why testing and proper prescription treatment are so important.

Wisp treatment options are available only after consultation with a licensed medical professional. You should consult with your healthcare provider before starting a new supplement or treatment regimen. Individual results may vary.

Why do BV and Chlamydia get confused?

BV and chlamydia can look a little similar, especially if you're uncertain of what to look for.

Both can change your vaginal discharge, and both can sometimes fly under the radar with no noticeable symptoms. That makes guessing what’s happening on your own tricky. Loads of people assume any unusual discharge is a yeast infection, but often it’s something else entirely.

The only way to know for sure? A proper test, even from home. This can help you get the right treatment quickly and keep your sexual health in check.

Can BV increase your risk of Chlamydia?

Having BV doesn’t automatically mean you’ll get chlamydia, but it has been shown that it can make your vaginal environment more inviting for STIs.

How BV affects your vaginal defenses

BV throws off your vagina’s natural defenses. The good bacteria that usually keep things acidic and healthy get crowded out, leaving space for STI-causing bacteria to move in.

Your immune system might be busy handling the imbalance, making it easier for infections like chlamydia to take hold. It’s like your vaginal defenses are multitasking—while fighting off BV, other infections can slip through.

Why BV can make Chlamydia last longer

If you have both BV and chlamydia, the infection may stick around longer. Studies show that BV disrupts your vaginal microbiome, which can make it harder for your body to clear chlamydia naturally.

Treating BV alongside chlamydia can help your body bounce back faster, so keeping an eye on both conditions and getting the right care matters.

How to spot BV and chlamydia

Knowing what to look for helps you take charge of your sexual health. Keep in mind that many women don’t notice any symptoms at all, so paying attention to subtle changes in your body can be the first step toward getting the right care.

What BV can look like

You might notice:

• Thin, grayish-white discharge
• Fishy odor that’s stronger after sex or during your period
• Mild burning when you pee
• Light irritation around the vaginal opening
• Less intense itching or swelling than with yeast infections

Pregnant people should be extra mindful, as BV during pregnancy can have more serious implications.

What Chlamydia can look like

Symptoms can be subtle or take 1–3 weeks to appear, including:

• Unusual discharge that may be yellowish or slightly off
• Light bleeding between periods or after sex
• Lower abdominal discomfort
• Pain during urination or sex

Because it can linger without obvious signs, regular testing is key. Once again, if you’re pregnant, it’s important to be extra careful. Chlamydia during pregnancy can have serious implications for both mom and baby—so get checked ASAP if anything feels off.

When BV and Chlamydia happen together

If you have both, you might notice:

• Fishy odor from BV masking subtle discharge changes from chlamydia
• More pronounced pelvic discomfort than with either condition alone
• Treatment might be trickier, so comprehensive testing is important
  

How to get diagnosed

You can’t always tell BV from chlamydia just by symptoms alone, so testing is key if you think it might be an STI. The good news is that modern telehealth and at-home kits make getting checked easy and discreet—no in-person waiting rooms or awkward appointments required.

Testing for BV

To figure out if it’s BV, healthcare providers look at things like your vaginal pH, discharge, and the types of bacteria present. Traditional lab methods like Gram stains or microscopy give the clearest picture, but at-home pH or vaginal health panels are a convenient first step. You can also look for at-home testing kits that check for BV, yeast, and overall vaginal health, with results in just a few days.

Testing for Chlamydia

Chlamydia testing is usually done with urine or vaginal swabs using super-sensitive NAAT tests that can catch even silent infections. Sexually active women under 25 are advised to screen yearly, and it’s smart to test before starting a new relationship.

At-home STI panels can test for chlamydia and gonorrhea at the same time. Results guide the right treatment without guesswork or unnecessary antibiotics.

When to reach out to a provider

Some signs should never wait. Severe pelvic pain, high fever, heavy bleeding, or symptoms that stick around or come back quickly mean it’s time to get checked. Pregnant people should be especially prompt about any unusual discharge.

Online consultations let you talk to a licensed provider quickly, get testing, and even get same-day prescriptions if needed—so you can tackle things before they turn serious.

How to treat BV and Chlamydia

Both BV and chlamydia respond well to the right antibiotics, but the specifics are a little different. You'll need to know what you're dealing with and how each is treated so you can actually feel in control of your sexual health.

Treating Bacterial Vaginosis

BV treatment involves prescription antibiotics.

One option is oral metronidazole for 7 days or a vaginal gel for 5 nights. (Always follow the directions on the prescription). Look out for any intense side effects, and reach out for help if you experience any:

• Serious swelling
• Itching
• Dizziness
• Stiffness in your neck
• Light sensitivity
• Changes in your heart rate
• Pain in your abdomen
• Pain, tingling, or numbness in your hands or feet

Clindamycin is another option if metronidazole isn’t a fit. If you’re taking clindamycin, diarrhea, nausea, some stomach aches, or having a weird metallic taste in your mouth are all pretty normal. But you should reach out to your provider if you experience:

• Anything that feels like an allergic reaction (hives, itching, swelling)
• A serious loss of appetite
• Throat pain or trouble swallowing
• Pain and sores inside your mouth
• Any seriously weird vaginal discharge

You'll probably feel relief within a couple of days, but it’s important to finish the full course. Some providers offer partner therapy for male partners since treating male partners can sometimes help lower recurrence.

Probiotics can also help support your vaginal health during and after the treatment. Quick tip: avoid alcohol while taking metronidazole, 'cause there can be some unpleasant side effects.

Treating Chlamydia

Chlamydia is also treated with antibiotics: either a single dose of azithromycin or a 7-day course of doxycycline—and as always, make sure to follow the dosage directions on your prescription.

With azithromycin, some mild side effects like nausea and headaches are normal, but reach out to your care team if you experience:

• Anything that feels like an allergic reaction (hives, itching, swelling)
• A serious loss of appetite
• Throat pain or trouble swallowing
• Pain and sores inside your mouth
• Any seriously weird vaginal discharge

And when it comes to doxycycline, you’re more likely to experience:

• Diarrhea
• Vaginal itching
• Pain during sex
• Thick, white vaginal discharge with a mild smell (or none at all)

Partners need treatment too, and you should skip sex for 7 days after azithromycin or until doxycycline is done. Retesting after 3 months is smart, since reinfections can happen!

How to keep your vaginal health on track

BV and chlamydia aren’t exactly the same, so prevention looks a little different.

Limiting products that mess with your vaginal pH, avoiding douching, and maintaining good hygiene can help with BV.

Using barrier methods consistently helps with chlamydia. Regular STI and vaginal health screening is also a smart move, and adding probiotics or maintaining healthy habits can support your vaginal ecosystem.

Don’t guess—get it checked

Knowing the difference between BV and chlamydia gives you the power to take action when something feels off. BV happens when your vaginal bacteria are out of balance, while chlamydia is a sexually transmitted disease that needs treatment for both you and your partner. Because BV can make it easier to catch other STIs, it’s worth paying attention to any changes in your body.

The good news? Testing and treatment don’t have to be complicated. Telehealth makes it easy to get discreet care from home, whether you’re noticing unusual discharge, worried about an STI, or just keeping up with routine screening. Both conditions are common, treatable, and nothing to feel shy about.

Take charge of your vaginal health—get tested and treated quickly through Wisp so you can feel confident and cared for.

This blog post is for informational and educational purposes only and should not be taken as professional advice. Always consult with a qualified professional before making any decisions based on the information provided here.