Bacterial infections and their association with female infertility: diagnostic and therapeutic perspectives

Infertility is a public health issue affecting millions of women of reproductive age worldwide. Bacterial infections caused by Chlamydia trachomatis, Neisseria gonorrhoeae, Mycoplasma hominis, and Ureaplasma urealyticum are among the most prevalent. They are associated with pelvic inflammatory disease, chronic endometritis, fallopian tube obstruction, impaired endometrial receptivity and implantation, and increased risk of ectopic pregnancy and pregnancy loss. Timely diagnosis using nucleic acid amplification testing represents the current standard, while advanced techniques, such as sequencing, enable the precise identification of pathogens and dysbiosis. The treatment of infections caused by these microorganisms involved the use of antibiotics, guided by the specific antimicrobial susceptibility pattern of each bacterium. Alternatives such as antioxidants, probiotics, or vaginal microbiota transplantation have been proposed for persistent infections. The clinical approach is interdisciplinary, incorporating imaging studies and inflammatory biomarkers. Understanding the pathogens and their interactions within the microbiome, along with the integration of reproductive medicine and clinical microbiology, provides valuable insights for managing and preserving female fertility.