Microbial Pathogens Linked to Vaginal Microbiome Dysbiosis and Therapeutic Tools for Their Treatment

The vaginal microbiome can be perturbed by various intrinsic and extrinsic factors, resulting in a state of dysbiosis that decreases the abundance of commensal lactobacilli and often leads to pathological conditions such as bacterial vaginosis, yeast infections, sexually transmitted infections, and other vaginal disorders. This narrative review explores the molecular and pathophysiological mechanisms of several microbial diseases associated with the dysbiosis of the vaginal microbiome, as well as the efficacy of therapeutic tools for these conditions, such as antibiotic treatment and the use of live biotherapeutic products. A non-systematic, narrative approach was employed. Searches and data extraction were performed using the PubMed and Scopus databases between January and February 2025. All reviewed studies reported vaginal microbiome dysbiosis, with microbial pathogens inducing a specific immune response in the host. Current treatments for vaginal microbiota dysbiosis-related pathologies often result in high relapse and recurrence rates, suggesting microbial resistance and the need for alternative therapeutic strategies. In turn, live biotherapeutic products have demonstrated beneficial effects, restoring microbial balance in dysbiotic conditions. While these findings suggest promising potential for live biotherapeutic products, further rigorous clinical studies are necessary to gain a deeper understanding of the female genital tract ecosystem and to identify novel biomarkers along with their associated health implications. Moreover, the development of new diagnostic and management strategies will facilitate personalized therapeutic approaches. Ultimately, a comprehensive perspective on vaginal care is pivotal, taking into account both microbial and immune dynamics to enhance women’s health outcomes.