The role of josamycin in the treatment of the lower genital tract inflammation in women

Cover Page

Cite item

Full Text

Open Access Open Access
Restricted Access Access granted
Restricted Access Subscription or Fee Access

Abstract

Inflammatory diseases of the lower female genital tract, including cervicitis and vaginitis, are among the most common causes for seeking medical attention from a gynecologist. These conditions can lead to severe complications, such as pelvic inflammatory diseases, infertility, miscarriage, and cervical neoplasia. These diseases are multifactorial in their origin: the causative agents are aerobic and anaerobic bacteria, as well as intracellular pathogens such as Chlamydia trachomatis, Mycoplasma genitalium, and Ureaplasma spp. In recent years, there has been a significant increase in antibiotic resistance, especially in intracellular microorganisms. This resistance complicates therapy and leads to the need for alternative antibacterial strategies.

Josamycin is one of the few macrolides that have high activity against M. genitalium, Ureaplasma spp. and M. hominis. It also has a favorable safety profile and can be used by pregnant women. The medication has been proven effective in treating chlamydia, mycoplasma, and mixed infections of the vagina and cervix, making it a popular choice for use in daily outpatient care. In 2025, the Russian generic of josamycin, Josafen, was registered and entered the pharmaceutical market. It is identical in all respects to the original medication and it is available in the form of a dispersible tablet. This form increases treatment adherence, provides predictable therapeutic effects, and reduces the risk of adverse reactions.

Conclusion: Josamycin (Josafen) plays an important role in modern gynecological practice as an effective and safe treatment for nonspecific cervicitis and vaginitis in reproductive-aged women and pregnant women as well. Its use makes it possible to increase the effectiveness of therapy, reduce the risk of relapses and improve reproductive outcomes.

Full Text

Restricted Access

About the authors

Inna A. Apolikhina

Academician V.I. Kulakov National Medical Research Centre for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia; I.M. Sechenov First Moscow State Medical University (Sechenov University), Ministry of Health of Russia

Author for correspondence.
Email: apolikhina@inbox.ru
ORCID iD: 0000-0002-4581-6295

Dr. Med. Sci., Professor, Head of the Department of Aesthetic Gynecology and Rehabilitation, Professor at the Department of Obstetrics, Gynecology, Perinatology, and Reproductology, Institute of Professional Education

Russian Federation, 117997, Russia, Moscow, Ac. Oparin str., 4; 119048, Moscow, Trubetskaya str., 8-2

Liana A. Tarnaeva

Academician V.I. Kulakov National Medical Research Centre for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia

Email: li.tarnaeva@ya.ru

obstetrician-gynecologist, PhD student at the Department of Aesthetic Gynecology and Rehabilitation

Russian Federation, 117997, Moscow, Ac. Oparin str., 4

References

  1. Groetsch S. Cervicitis. Clinics in family practice. 2025; 7(1): 43-56. https://dx.doi.org/10.1016/j.cfp.2005.01.002
  2. Vodstrcil L.A., Plummer E.L., Nguyen T.V.., Fairley CK., Chow E.P.F., Phillips T.R. et al. Trends in infections detected in women with cervicitis over a decade. Front. Reprod. Health. 2025; 7: 1539186. https://dx.doi.org/10.3389/frph.2025.1539186
  3. Copete A., Herrera M., Suarez-Ariza C., Gitau Z., Arango-Uribe M., Keynan R. et al. Mycoplasma genitalium infections and associated antimicrobial resistance in Canada, 1980–2023. Trop. Med. Infect. Dis. 2025; 10(5): 139. https://dx.doi.org/10.3390/tropicalmed10050139
  4. Li M., Li L., Wang R., Yan S.M., Ma X.Y., Jiang S. et al. Prevalence and risk factors for bacterial vaginosis and cervicitis among 511 female workers attending gynecological examination in Changchun, China. Taiwan. J. Obstet. Gynecol. 2019; 58(3): 385-9. https://dx.doi.org/10.1016/j.tjog.2018.11.036
  5. Wiesenfeld H.C., Manhart L.E. Mycoplasma genitalium in women: current knowledge and research priorities for this recently emerged pathogen. J. Infect. Dis. 2017; 216(suppl_2): S389-S395. https://dx.doi.org/10.1093/infdis/jix198
  6. Hetem D.J., Kuizenga Wessel S., Bruisten S.M., Braam J.F., van Rooijen M.S., Vergunst C.E. et al. High prevalence and resistance rates of mycoplasma genitalium among patients visiting two sexually transmitted infection clinics in the Netherlands. Int. J. STD AIDS. 2021; 32(9): 837-44. https://dx.doi.org/10.1177/0956462421999287
  7. Trembizki E., Buckley C., Bletchly C., Nimmo G.R., Whiley D.M. High levels of macrolide-resistant Mycoplasma genitalium in Queensland, Australia. J. Med. Microbiol. 2017; 66(10): 1451-3. https://dx.doi.org/10.1099/jmm.0.000584
  8. Donders G.G.G., Bellen G., Grinceviciene S., Ruban K., Vieira-Baptista P. Aerobic vaginitis: no longer a stranger. Res. Microbiol. 2017; 168(9-10): 845-58. https://dx.doi.org/10.1016/j.resmic.2017.04.004
  9. Ortiz-de la Tabla V, Gutiérrez F. Cervicitis: Etiology, diagnosis and treatment. Enferm. Infecc. Microbiol. Clin. (Engl. Ed). 2019; 37(10): 661-7. English, Spanish. https://dx.doi.org/10.1016/j.eimc.2018.12.004
  10. Хрянин А.А. Урогенитальная хламидийная инфекция у женщин: современные подходы к лечению согласно российским и зарубежным рекомендациям. Вестник дерматологии и венерологии. 2015; 2: 101-10. [Khryanin A.A. Urogenital Chlamydia infection in women: patient management tactics according to present-day foreign and Russian recommendations. Bulletin of Dermatology and Venereology. 2015; (2): 101-10 (in Russian)].
  11. Couldwell D.L., Lewis D.A. Mycoplasma genitalium infection: current treatment options, therapeutic failure, and resistance-associated mutations. Infect. Drug. Resist. 2015; 8: 147. https://dx.doi.org/10.2147/IDR.S48813
  12. Workowski K.A., Bachmann L.H., Chan P.A., Johnston C.M., Muzny C.A., Park I. et al. Sexually transmitted infections treatment guidelines, 2021. MMWR Recomm. Rep. 2021; 70(4): 1-187. https://dx.doi.org/10.15585/mmwr.rr7004a1
  13. Unemo M., Jensen J.S. Antimicrobial-resistant sexually transmitted infections: gonorrhoea and mycoplasma genitalium. Nat. Rev. Urol. 2017; 14(3): 139-52. https://dx.doi.org/10.1038/nrurol.2016.268
  14. Bradshaw C.S., Brotman R.M. Making inroads into improving treatment of bacterial vaginosis – striving for long-term cure. BMC Infect. Dis. 2015; 15(1): 292. https://dx.doi.org/10.1186/S12879-015-1027-4
  15. Vodstrcil L.A., Plummer E.L., Fairley C.K., Hocking J.S., Law M.G., Petoumenos K. et al. Male-partner treatment to prevent recurrence of bacterial vaginosis. N. Engl. J. Med. 2025; 392(10): 947-57. https://dx.doi.org/10.1056/NEJMoa2405404
  16. Rodrigues R., Marques L., Vieira-Baptista P., Sousa C., Vale N. Therapeutic options for chlamydia trachomatis infection: present and future. Antibiotics (Basel). 2022; 11(11): 1634. https://dx.doi.org/10.3390/antibiotics11111634
  17. Bryskier A., Labro M.T. [Macrolides. New therapeutic prospects]. Presse Med. 1994; 23(38): 1762-6. French.
  18. Фофанова И.Ю., Прилепская В.Н. Возможности терапии урогенитальной микоплазменной инфекции при беременности. Трудный пациент. 2009; 12(7): 17-23. [Fofanova I.Yu., Prilepskaya V.N. Possibilities of therapy of urogenital mycoplasma infection in pregnancy. Difficult patient. 2009; 12(7): 17-23 (in Russian)].
  19. WHO guidelines for the treatment of Chlamydia trachomatis. Geneva: World Health Organization; 2016. 56 p. Available at: https://iris.who.int/bitstream/handle/10665/246165/9789241549714-eng.pdf?sequence=1
  20. Рахматулина М.Р., Шашкова А.А. Клиническое значение выявления генитальных микоплазм и современные показатели чувствительности Ureaplasma и M. hominis к антибактериальным препаратам. Акушерство и гинекология. 2016; 12: 137-42. [Rakhmatulina M.R., Shashkova A.A. Clinical significance of detection of genital mycoplasmas and current indicators of sensitivity of Ureaplasma and M. hominis to antibacterial drugs. Obstetrics and Gynecology. 2016; (12): 137-42 (in Russian)]. https://dx.doi.org/10.18565/aig.2016.12.137-42
  21. Эйдельштейн И.А., Гущин А.Е., Гладин Д.П., Романов А.В., Негашева Е.С., Фриго Н.В., Козлов Р.С., Потекаев Н.Н., Козлова Н.С., Борухович Д.Г. Высокая распространенность резистентности к макролидам и фторхинолонам у Mycoplasma genitalium, выделенных у пациентов из двух мегаполисов России – Москвы и Санкт-Петербурга в 2021–2024 гг. КМАХ. 2024; 3(26): 356-69. [Eidelstein I.A., Gushchin A.E., Gladin D.P., Romanov A.V., Negasheva E.S., Frigo N.V., Kozlov R.S., Potekaev N.N., Kozlova N.S., Borukhovich D.G. High prevalence of resistance to macrolides and fluoroquinolones in Mycoplasma genitalium isolated from patients in two Russian megacities, Moscow and St. Petersburg, in 2021–2024. KMAH. 2024; 3(26): 356-69 (in Russian)]. https://dx.doi.org/10.36488/cmac.2024.3.356-369
  22. Jensen J.S., Cusini M., Gomberg M., Moi H., Wilson J., Unemo M. 2021 European guideline on the management of Mycoplasma genitalium infections. J. Eur. Acad. Dermatol. Venereol. 2022; 36(5): 641-50. https://dx.doi.org/10.1111/JDV.17972
  23. Guschin A., Ryzhikh P., Rumyantseva T., Gomberg M., Unemo M. Treatment efficacy, treatment failures and selection of macrolide resistance in patients with high load of Mycoplasma genitalium during treatment of male urethritis with josamycin. BMC Infect. Dis. 2015; 15(1): 40. https://dx.doi.org/10.1186/s12879-015-0781-7
  24. Koumaki V., Chasiakou A., Kantzanou M., Tsakris A., Baka S. Antimicrobial resistance of genital mycoplasmas recovered from nonpregnant women in Greece: trends over the last 15 years. Future Microbiol. 2024; 19(10): 867-75. https://dx.doi.org/10.2217/fmb-2023-0238
  25. Primiero F.M., Caruso G., Grottanelli F., Chiarini F., De Stasio A., Guarino M. et al. Josamycin in the treatment of Chlamydia trachomatis cervicitis. J. Chemother. 1989; 1(4S): 909-10.
  26. Söltz-Szöts J., Schneider S., Niebauer B., Knobler R.M., Lindmaier A. [Significance of the dose of josamycin in the treatment of chlamydia infected pregnant patients]. Z. Hautkr. 1989; 64(2): 129-31. German.
  27. Аполихина И.А., Горбунова Е.А., Додова Е.Г., Гасанова Г.Ф. Современные аспекты комбинированной антибактериальной терапии неспецифических вагинитов и цервицитов (результаты неинтервенционного исследования «Баланс»). Акушерство и гинекология. 2015; 8: 70-7. [Apolikhina I.A., Gorbunova E.A., Dodova E.G., Gasanova G.F. Current aspects of combination antibiotic therapy for nonspecific vaginitis and cervicitis: Results of the non-interventional study Balance. Obstetrics and Gynecology. 2015; (8): 70-7 (in Russian)].
  28. Páez-Canro C., Alzate J.P., González L.M., Rubio-Romero J.A., Lethaby A., Gaitán H.G. Antibiotics for treating urogenital chlamydia trachomatis infection in men and non-pregnant women. Cochrane Database Syst. Rev. 2019; 1(1): CD010871. https://dx.doi.org/10.1002/14651858.CD010871.pub2
  29. Kohlhoff S.A., Hammerschlag M.R. Treatment of Chlamydial infections: 2014 update. Expert Opin. Pharmacother. 2015; 16(2): 205-12. https://dx.doi.org/10.1517/14656566.2015.999041
  30. Jensen J.S., Bradshaw C. Management of Mycoplasma genitalium infections – can we hit a moving target? BMC Infect. Dis. 2015; 15: 343. https://dx.doi.org/10.1186/s12879-015-1041-6
  31. Инструкция по медицинскому применению препарата «Джозафен». Рег. №: ЛП-(007138)-(РГ-RU) от 07.10.24 [Instructions for medical use of the drug "Josaphen". Reg. No.: LP-(007138)-(RG-RU) dated October 7, 2024 (in Russian)]. https://www.vidal.ru/drugs/dzhozafen
  32. Общая характеристка лекарственного препарата «Джозафен». ЛП-N=(007138)-(РГ-RU) от 07.10.24. Доступно по: https://lk.regmed.ru/Register/EAEU_SmPC [General characteristics of the drug "Josaphen". LP-N=(007138)-(RG-RU) dated 07.10.24 Available at: https://lk.regmed.ru/Register/EAEU_SmPC (in Russian)].
  33. Портнягина Е.В., Раднаев Г.Г. Рациональная антибактериальная терапия и вопросы предупреждения бактериальной резистентности. Иркутск: ИГМУ; 2022. 135 c. [Portnyagina E.V., Radnaev G.G. Rational antibacterial therapy and issues of preventing bacterial resistance. Irkutsk: ISMU; 2022. 135 p. (in Russian)].
  34. ГРЛС. https://grls.minzdrav.gov.ru/GRLS.aspx?isfs=0®type=1,6&pageSize=10&order=Registered&orderType=desc&pageNum=1&MnnR=джозамицин&token=0ede4f62-9c77-4cec-b236-d5d90d8287e9 (дата обращения 15.09.2025) [State Register of Medicines. https://grls.minzdrav.gov.ru/GRLS.aspx?isfs=0®type=1,6&pageSize=10&order=Registered&orderType=desc&pageNum=1&MnnR=джозамицин&token=0ede4f62-9c77-4cec-b236-d5d90d8287e9 (accessed 15.09.2025) (in Russian)].

Supplementary files

Supplementary Files
Action
1. JATS XML
Download

Copyright (c) 2025 Bionika Media