Staphylococcus hemolyticus as an emerging infectious agent in female genital and urinary tract: a narrative review

Staphylococcus haemolyticus (S. haemolyticus), a coagulase-negative staphylococcus (CoNS), has traditionally been considered a harmless skin commensal. However, accumulating clinical evidence over the past two decades has revealed its potential as an opportunistic pathogen, particularly in healthcare-associated infections. More recently, its role in urogenital infections among sexually active females has come under increasing scrutiny. S. haemolyticus has been isolated from vaginal and urinary tract specimens with growing frequency, often associated with urinary tract infections (UTIs), vaginitis, and vaginal dysbiosis, especially in cases of recurrent or antibiotic-refractory symptoms. Despite being frequently dismissed as a contaminant, it has a strong biofilm-forming capacity, hemolytic activity, adhesins, and resistance to host immune responses. A key concern is its widespread resistance to multiple antibiotic classes, including β-lactams, macrolides, aminoglycosides, and in some cases, glycopeptides such as vancomycin. This multidrug resistance, combined with biofilm-mediated persistence, significantly complicates empirical treatment approaches and may contribute to treatment failure and recurrence. Accurate identification, often requiring advanced tools such as VITEK 2, MALDI-TOF MS (Matrix Assisted Laser Desorption/Ionization Time-of-Flight Mass Spectrometry), and PCR (Polymerase Chain Reaction) based methods, is crucial for guiding appropriate management. Preventive strategies, including hygiene education, microbiome support through probiotics, and surveillance for resistant strains, are essential, particularly in high-risk populations. This review highlights the emerging clinical relevance of S. haemolyticus in sexually active women, explores its microbiological and pathogenic characteristics, and discusses current diagnostic and therapeutic challenges. Ultimately, it highlights the pressing need for additional research into its virulence mechanisms, epidemiology, and novel treatment strategies, including biofilm-targeting and microbiome-sparing approaches, to mitigate its growing public health impact.