BV and Yeast Infections#

• Treatment for BV and yeast through TeleTest is available across all Canadian provinces where TeleTest operates.
• Self-administered vaginal swab testing is currently available at LifeLabs locations in Ontario only, due to lab supply issues. The specific swab is not currently stocked at Dynacare or at LifeLabs locations in BC.
• BC patients can still receive BV / yeast treatment through TeleTest if your clinician determines treatment without a confirmatory test is appropriate (commonly for recognized recurrences).

Bacterial vaginosis (BV) is a change in the balance of normal vaginal bacteria - specifically, a shift away from the "good" bacteria (Lactobacillus, which keeps the vagina mildly acidic) toward a more diverse mix of bacteria. This shift causes the vaginal pH to rise.

Typical signs of BV:

• Off-white, thin discharge.
• A "fishy" odour that's often more noticeable after sex or during menstruation.
• Usually no significant itching (which helps distinguish it from a yeast infection).

BV is not a sexually transmitted infection - it's a shift in your own vaginal flora. People who have never been sexually active can develop BV, and many sexually active people without any STI can also have BV.

A yeast infection (medical term: vulvovaginal candidiasis) is caused by overgrowth of a fungus called Candida. The most common species is Candida albicans. Less commonly, other species like Candida glabrata are involved and these can be harder to treat with standard antifungals.

Typical signs of a yeast infection:

• Intense itching of the vulva and vagina.
• Thick, curd-like or cottage-cheese-like discharge with little or no odour.
• Vulvar redness or swelling.

Common risk factors:

• Recent antibiotic use (antibiotics disrupt the normal flora that keep yeast in check).
• Diabetes, especially if poorly controlled.
• High estrogen levels (pregnancy, hormone therapy, combined oral contraceptives in some cases).
• A weakened immune system (certain medications, HIV, recent chemotherapy).
• Tight or damp clothing worn for long periods.

Testing for BV or yeast is not appropriate when you have no symptoms. This is one of the most important things to understand about vaginal-discharge testing: the vagina is not a sterile environment, and many of the same organisms detected on swabs are part of normal vaginal flora in healthy people.

Why asymptomatic testing isn't useful:

• Yeast (Candida) colonization is common and normal. Approximately 10-20% of healthy women carry Candida in their vagina without any symptoms at all. A positive yeast test in an asymptomatic person reflects normal carriage, not infection.
• A BV-pattern flora is also common in asymptomatic women. Some studies find that a substantial proportion of healthy women have a vaginal flora pattern that would be reported as "consistent with BV" on a swab - despite having no symptoms and being completely well.
• A positive result without symptoms is not a diagnosis - it's a finding. Treating colonization in asymptomatic people:
  • Uses antibiotics or antifungals unnecessarily.
  • Disrupts the natural vaginal flora and can paradoxically trigger the very imbalance that causes BV.
  • Contributes to antibiotic and antifungal resistance.
  • Creates anxiety and adds a "diagnosis" that isn't medically meaningful.

The clinical principle is the same as for other vaginal-flora organisms (see Ureaplasma / Mycoplasma): symptoms drive testing decisions - not curiosity, partner status alone, or a desire for a "complete check."

If you have no symptoms but want reassurance about your vaginal health, the most useful steps are:

• Stay current with cervical screening (Pap or HPV testing) - this is the cancer-screening test for the cervix and is far more clinically meaningful than swabbing without symptoms. See Pap and HPV Cervical Screening.
• Standard STI screening if you've had a new partner exposure or have a specific concern.
• Symptom-driven swab testing when (and only when) symptoms appear.

Less commonly, vaginal discharge can be a sign of:

• Sexually transmitted infections - order the STI testing panel. The standard BV / yeast swab does not detect:
  • Chlamydia and gonorrhea - urine PCR is required.
  • Trichomoniasis - this is one of the most commonly missed causes of vaginal discharge because some panels do not include it by default. If you have unusual discharge and have been tested for STIs in the past, double-check that your STI panel included trichomoniasis testing - if not, ask your clinician to add it.
• Cervical or endometrial conditions, including, rarely, cancer.
• Foreign body (e.g., a forgotten tampon, retained condom fragment).
• Irritation from products used in the vaginal area (soaps, douches, scented sanitary products).

If your TeleTest swab is normal and symptoms persist, an in-person assessment at a walk-in clinic is the right next step. A speculum exam to assess the cervix is something we can't do virtually, and a visual cervical exam can identify causes (cervicitis, polyps, lesions, contact bleeding) that no remote test will catch.

Often yes - particularly if you've had a confirmed BV or yeast infection before and recognize the same symptoms. The clinician will review your intake and decide on a case-by-case basis.

Testing first is the safer route when:

• It's a first-time episode and you're not certain it's BV or yeast.
• Symptoms are severe or unusual.
• Symptoms are recurrent (3+ BV or 4+ yeast episodes in a year).
• You're pregnant - treatment choices are different in pregnancy and confirmation matters.
• You're uncertain what's causing the symptoms or have any concerning symptoms (fever, chills, abdominal pain, feeling generally unwell).

The vaginal BV / yeast swab does not test for chlamydia, gonorrhea, trichomoniasis, herpes, or other STIs. Reasons to also include STI testing:

• New partner exposure.
• Concerns about partner infidelity or partner STI risk.
• Symptoms that could overlap with an STI (urinary burning, pelvic pain, abnormal discharge with non-classic features).

You don't need to submit two separate consultations. If you also want STI testing, just select the STI Testing and Treatment panel instead - mention your vaginal symptoms in the intake, and BV / yeast swab testing can be added on the basis of those symptoms within the same consultation and requisition.

You can then do both the BV / yeast vaginal swab and the STI urine sample from a single lab visit.

1. Order the BV / Yeast Infection panel on teletest.ca.
2. Complete the intake describing your symptoms.
3. Submit your intake. A clinician reviews and approves a requisition - you'll receive a secure message in your patient portal.
4. Visit a LifeLabs location in Ontario and ask for the self-administered vaginal swab (Charcoal C & S swab). No appointment needed. You collect the swab yourself in the lab's washroom using a kit they provide - the lab staff do not collect it for you. The self-collected vaginal swab is currently available at LifeLabs Ontario locations only - not at Dynacare and not at LifeLabs in BC. See How to Do My Own Self-Swab for the technique.
5. Drop the swab off with the lab technician. The lab processes it and uploads the result to your TeleTest portal when it's released. Culture turnaround is typically about a week to ten days, depending on the lab and the result.
6. If BV or a yeast infection is confirmed, a follow-up message appears in your portal at no additional fee. The clinician will discuss treatment options and prescribe if appropriate.

This is a common situation, and it can be frustrating. We've had many patient experiences where lab staff at a community-lab location are unaware that the self-collected vaginal swab kit is approved and available at their site. The kit (Charcoal C & S swab) is in fact supplied to LifeLabs Ontario locations and is approved for self-collection through the TeleTest requisition, but not every team member is familiar with the protocol - particularly newer staff or at quieter locations.

What to do:

1. Ask specifically for the Charcoal C & S swab kit for self-collection - this is what's on the TeleTest requisition. The specific kit name usually helps staff locate it.
2. If the kit isn't immediately available at the location you're at, ask staff to order it in, or try a different LifeLabs Ontario site.
3. If you've checked multiple locations and the swab still isn't available, please contact us and let us know which sites. We can coordinate directly with the lab's head office to confirm stock and ensure staff at your local site are familiar with the self-collection protocol.

Helping you avoid having to seek sensitive vaginal-discharge testing through another provider is something we take seriously - please reach out if you run into this.

No - the urine and the vaginal swab are independent samples and don't interfere with each other. You can do both at the same lab visit.

Requisitions reflect the symptoms you reported at the time of your consultation. If you were asymptomatic at the time, your requisition won't include BV / yeast swab testing.

If you develop new symptoms later, you have two options:

1. Visit a local walk-in clinic for in-person assessment and testing.
2. Submit a new TeleTest consultation with your updated symptoms - the clinician will review and order the appropriate testing.

BV is treated with an antibiotic. Multiple routes are available - your clinician will choose based on your preference, pregnancy status, allergies, and prior treatment history.

Oral antibiotic (first-line for most patients):

• A short course taken twice daily for 5-7 days of an antibiotic from a specific class.
• ⚠️ Alcohol avoidance is essential with the first-line oral BV antibiotic. This medication interacts with alcohol and can cause a severe reaction with intense nausea, vomiting, flushing, headache, and a racing heart - even a small amount of alcohol can trigger it.
• Avoid alcohol completely during treatment and for at least 48-72 hours after your last dose. Your clinician will give you a specific timeframe.
• Avoid medications and oral-rinse products that contain alcohol during this window as well.

Topical (vaginal) options:

• Vaginal antibiotic gel applied at bedtime for 5-7 days.
• Vaginal antibiotic cream or ovules (a different antibiotic class) - typically 3-7 days depending on formulation.
• Topical routes are often preferred when:
  • You cannot tolerate the oral antibiotic.
  • You cannot reliably avoid alcohol during the treatment window.
  • You are pregnant (specific topicals are pregnancy-safe).
  • You prefer a localized approach with fewer systemic side effects.
• Topical products can cause some leakage during the treatment period - a pantyliner is helpful.

While being treated (any route):

• Finish the full course even if symptoms improve quickly.
• Avoid douching - it's a common BV trigger and should be avoided as a general practice, not just during treatment.
• Consider using a condom or abstaining from sex during treatment if your symptoms include odour that worsens after sex - semen can shift vaginal pH and trigger flares while you are healing.
• Specific medication names are discussed during your consultation rather than published here, in line with Health Canada Section C.01.044 restrictions on patient-facing prescription-drug information.

A yeast infection is treated with an antifungal medication. Several routes are available:

Oral antifungal (prescription):

• A single oral dose is the most common prescription approach for uncomplicated yeast.
• For severe symptoms, two doses given 72 hours apart may be used.
• Generally not used in pregnancy because of fetal-development concerns - topical routes are preferred during pregnancy.

Topical (vaginal) antifungal options:

• Vaginal antifungal cream applied with an applicator at bedtime for 1, 3, or 7 days depending on the strength of the formulation.
• Vaginal antifungal suppositories or ovules for 1, 3, or 7 days depending on dose.
• External vulvar antifungal cream applied to the vulva to relieve itching and inflammation on the outside.
• Topical routes are preferred during pregnancy and are reasonable first-choice options for any patient who prefers a localized approach.

Over-the-counter (OTC) options: Many vaginal antifungal creams and suppositories are available at any pharmacy without a prescription for uncomplicated yeast infections. You may choose to try OTC treatment first - they work well for most patients with classic symptoms - and only consult TeleTest if symptoms don't improve.

See a clinician (TeleTest or in person) if:

• This is your first episode and you're not certain it's a yeast infection.
• Symptoms are severe or recurrent.
• You are pregnant (treatment choices are different in pregnancy - topical treatment is preferred).
• You are immunocompromised or have diabetes.
• You're unsure what's causing the symptoms.

Recurrent BV is commonly defined as 3 or more BV episodes in 12 months. It is one of the most common reasons women seek vaginal-discharge care, and unfortunately one of the more difficult conditions to treat long-term - standard treatment clears the current episode but does not reliably prevent the next one.

• Douching - one of the strongest modifiable risk factors. Avoid completely.
• New or multiple sexual partners.
• Female sexual partners who also have BV - in same-sex partnerships, BV often "ping-pongs" between partners.
• Certain sexual practices that introduce non-vaginal flora (sex toys shared between partners or between sites without cleaning, anal sex without changing condoms before vaginal contact).
• Semen exposure inside the vagina. Semen has a higher (more alkaline) pH than the normally acidic vaginal environment. Unprotected sex with internal ejaculation can temporarily shift vaginal pH and disrupt the Lactobacillus-dominant flora, which is the trigger for BV in susceptible patients. In TeleTest's clinical experience, some patients with recurrent BV identify unprotected sex with internal ejaculation as a personal trigger - using a condom can reduce this exposure.
• Antibiotic use for unrelated infections.
• An intrauterine device (IUD) - some studies show a modest association.

• Extended initial course - longer than the standard treatment (typically 10-14 days).
• Suppressive (maintenance) therapy - a topical antibiotic gel applied to the vagina twice weekly for 4-6 months has the best evidence for reducing recurrence during the maintenance period.
• Lifestyle modifications: stop douching, use breathable cotton underwear, avoid scented products in the vaginal area, consider non-spermicide contraception if you've been using spermicides.
• Probiotics containing certain Lactobacillus strains: some evidence supports adjunctive use after antibiotic treatment, but probiotics are not first-line.

Approach depends on the partner's gender:

• Male partners: historically not recommended because earlier studies showed no benefit. A 2024 randomized trial (Vodstrcil et al., New England Journal of Medicine) reported that combined oral + topical antibiotic treatment of male partners reduced BV recurrence in female partners. This is emerging evidence, not yet a standard of care in Canadian or international guidelines. TeleTest is currently reviewing this evidence and does not yet offer treatment to male partners of patients with BV. Patients interested in this approach can discuss it with a sexual-health clinic or gynaecologist.
• Female partners with BV symptoms can request their own BV consultation and treatment through TeleTest; treating both partners can help interrupt the "ping-pong" pattern.

If BV keeps recurring despite treatment, a few additional checks help rule out other causes:

• Make sure your STI testing included trichomoniasis. Trichomoniasis can cause symptoms similar to BV and is missed by the standard BV swab. Double-check that your most recent STI panel included trich, or request testing if not.
• Ensure your cervical screening (Pap or HPV) is up to date. Cervical abnormalities can sometimes contribute to abnormal discharge or odour. See Pap and HPV Cervical Screening for the current Canadian programs.
• Consider Mgen (Mycoplasma genitalium) testing if symptoms keep recurring despite normal BV swabs, normal STI screens (including trich), and up-to-date cervical screening. Mgen can cause cervicitis and abnormal discharge, is not part of the standard STI panel, and is increasingly recognized as a cause of persistent symptoms in women. See Mycoplasma genitalium.
• If all of the above is negative and symptoms persist, request an in-person visual cervical exam. A speculum exam can identify cervicitis, polyps, lesions, or other findings that remote testing cannot catch.

Recurrent vulvovaginal candidiasis (RVVC) is defined as 4 or more symptomatic yeast infections in a 12-month period. It affects approximately 5-8% of women at some point in their lives.

• Recurrence often reflects persistent low-level Candida colonization that flares whenever conditions favour fungal growth.
• Some recurrent infections are caused by non-albicans species (e.g., Candida glabrata) that are resistant to first-line antifungals - this is one reason standard treatment can fail.
• Risk factors (diabetes, a weakened immune system, high estrogen states, frequent antibiotic use) are more often relevant in recurrent disease and may need to be addressed directly.

No - species identification is not routinely available through Canadian community labs. Standard provincial lab cultures (LifeLabs, Dynacare) typically report "yeast" or "Candida" present without distinguishing between Candida albicans and non-albicans species. TeleTest cannot order speciation - the labs don't currently offer this as a routine test.

A note on recurrent vaginitis (RVV) molecular panels: some specialty / private labs offer RVV multiplex molecular panels that test simultaneously for BV, yeast (with species identification), trichomoniasis, and other vaginal-flora organisms. TeleTest does not currently offer an RVV panel. If you're interested in this kind of testing or in coordinating it with a specialist, please contact us - we can discuss whether it's the right next step for you.

TeleTest does not currently offer RVVC treatment. Patients with confirmed RVVC are best managed by a gynaecologist, family doctor, or sexual-health clinic that can provide longitudinal suppressive therapy and follow-up. The standard approach is summarized below for your information:

RVVC treatment generally uses a two-phase approach:

1. Induction phase - clear the current infection:

• A longer antifungal course than a standard yeast infection, typically 7-14 days of oral or topical antifungal.

2. Maintenance (suppression) phase - prevent recurrence:

• A weekly oral antifungal for 6 months after induction is the most evidence-based approach.
• Studies show this reduces recurrence rates substantially during the maintenance period.
• About 30-50% of women relapse within a few months of stopping maintenance, so long-term management often involves repeated suppression cycles or addressing modifiable risk factors.

If you have RVVC and want help getting connected with appropriate in-person care, please contact us - we can help point you in the right direction.

Repeated treatment failure raises the suspicion of a non-albicans species (e.g., Candida glabrata), which is often resistant to first-line antifungals.

• TeleTest cannot order speciation testing (as above), so confirming a non-albicans species typically requires specialist referral.
• Referral to a gynaecologist or infectious-disease specialist is the right next step. Specialty centres may have access to speciation testing through reference labs and can treat empirically with non-azole regimens.
• The most-studied alternative regimen is boric acid vaginal capsules (prepared by a compounding pharmacy) - these are used in specialty settings rather than routinely prescribed.

• Diabetes control if applicable - poorly controlled blood sugar is a major driver of RVVC.
• Review medications that may be contributing (oral hormonal contraceptives in some patients, immunosuppressants if any).
• Avoid unnecessary antibiotic use - each course of antibiotics can trigger a yeast flare by disrupting normal flora.
• Wear breathable cotton underwear and avoid prolonged time in damp swimwear or workout clothing.

If standard treatment fails or you have multiple risk factors, an in-person assessment by your family doctor, gynaecologist, or sexual-health clinic is recommended to investigate underlying causes. Before referral, check the following are covered:

• Confirm your STI testing included trichomoniasis - trich can sometimes be misattributed to recurrent yeast.
• Ensure your cervical screening (Pap or HPV) is up to date (see Pap and HPV Cervical Screening).
• Consider Mgen (Mycoplasma genitalium) testing if symptoms continue with negative routine STI and yeast testing. Mgen is not part of the standard STI panel and is a recognized cause of persistent vaginal / cervical symptoms. See Mycoplasma genitalium.
• If all of the above is negative and symptoms persist, an in-person speculum exam is warranted to look for cervical or vulvovaginal findings that remote testing can't catch.

• Coordinate with your prenatal-care provider - they will guide BV and yeast treatment during pregnancy.
• BV in pregnancy is treated - untreated BV in pregnancy has been associated with preterm birth in some studies. Treatment is usually with an antibiotic that is considered safe in pregnancy; topical and oral options exist.
• Yeast infections in pregnancy are common (high estrogen makes recurrence more likely). Topical antifungal treatment is preferred during pregnancy; oral antifungals are generally not used because of fetal-development concerns.
• TeleTest does not manage pregnancy directly - we can support BV / yeast testing and treatment in pregnancy in coordination with your prenatal team.

Generally no. BV is a shift in your own vaginal flora, and yeast is overgrowth of fungus normally present in small amounts - neither is an infection transmitted from a partner in the usual STI sense.

One emerging caveat for BV: a 2024 randomized trial suggested that treating male partners of patients with recurrent BV may reduce recurrence in the affected patient (see the recurrent-BV partner accordion above for details). This is not yet a standard of care, and TeleTest is reviewing the evidence. Treatment of an asymptomatic partner is not currently offered through TeleTest outside the female-partner-with-symptoms scenario.

Yes - the vaginal culture through the provincial public-health laboratory is covered by your provincial health plan when ordered by a clinician for an eligible resident. The lab fee for the test itself is not billed to you.

TeleTest's consultation fee is paid out-of-pocket - this covers the asynchronous clinician review that authorizes the requisition. The lab test itself remains covered.

Treatment prescriptions are subject to your regular drug-coverage situation (private insurance, provincial drug plan if eligible, or out-of-pocket). Over-the-counter antifungal products for uncomplicated yeast infections are paid out-of-pocket at the pharmacy.

If you're not an eligible resident (no provincial health card or out-of-province), additional uninsured lab fees may apply.

Yes. Cervical-cancer screening is changing in Canada, but you should still be screened on the recommended schedule regardless of whether you have BV or yeast symptoms.

• BC moved to HPV self-screening at home as the primary method in January 2024.
• Ontario moved to HPV-primary screening with reflex cytology under the Ontario Cervical Screening Program in March 2025.

You should get cervical screening even if you:

• Feel healthy and have no symptoms.
• Are no longer sexually active.
• Have only had one sexual partner.
• Are in a same-sex relationship.
• Have been through menopause.
• Have no family history of cervical cancer.
• Have received the HPV vaccine.

TeleTest does not currently offer cervical screening - visit your family doctor, a walk-in clinic, a sexual-health clinic, or a public-health unit. For the full picture on how the BC and Ontario programs work, see Pap and HPV Cervical Screening.