<p>Fecal contamination poses a persistent global threat to drinking water safety, especially in low- and middle-income countries with limited sanitation and treatment infrastructure. Fecal matter transmits a wide array of enteric pathogens like bacteria (<i>Escherichia coli</i>, <i>Vibrio cholerae</i>, <i>Salmonella</i>, <i>Shigella</i>), viruses (norovirus, rotavirus, adenoviruses), protozoa (<i>Giardia</i>, <i>Cryptosporidium</i>), and occasionally fungi and helminths—driving outbreaks of diarrheal diseases, cholera, and other waterborne illnesses that cause substantial morbidity and childhood mortality. This review synthesizes current knowledge on the sources, environmental survival, and transmission behavior of fecal-associated microbes in drinking water systems, including persistence in biofilms, seasonal fluctuations, and distribution network dynamics. It critically compares detection methods, from conventional culture-based techniques to advanced molecular tools that provide greater speed, specificity, and field applicability. The paper also evaluates remediation approaches, contrasting established physical-chemical treatments (coagulation–sedimentation, filtration, UV disinfection, chlorination) with sustainable, eco-friendly alternatives such as bioremediation, phytoremediation, bacteriophage therapy, predatory bacteria, and biosurfactant use, which offer low-cost, chemical-free pathogen control. Effective integration of sensitive detection technologies with targeted, sustainable remediation strategies supported by quantitative microbial risk assessment is essential to reduce fecal pollution risks and protect public health. The review calls for adaptive, multi-barrier water management frameworks to achieve safer drinking water globally.</p> Graphical Abstract <p></p>