STI's

1. Chancre
2. 4-6 wks

1. Fever
2. Rash
3. Liver infection
4. Swollen lymph nodes

1. Gumma
   1. Soft granular lesion
2. Antibiotic resistance
   1. Immune complexes
      1. Inflammation
      2. Tissue destruction

1. Skin lesions
2. Deafness
3. Bone malformation

1. Salvarsan

1. Penicillin

1. Tpr outer membrane protein
   1. Phase variation
      1. Poly G tract
         1. <8 = transcribed
         2. >8 = reduced transcription
         3. Strand slippage and excision repair
   2. Tpr K
      1. Antigenic variation

1. PCR
2. Immunoassays

1. Doxycyclin

1. Cross linked membrane proteins
   1. MOMP
      1. OmpA

1. Epididymis inflammation
2. Painful urination, water discharge

1. Cervical inflammation
   1. Immune activation
      1. Infected cells secrete IL's and GM-CSF
         1. Attract immune cells
            1. Fibrosis and scarring
2. Painful urination, vaginal discharge
3. PID
   1. Fallopian tube adhesions
   2. Infertility
   3. Ectopic pregnancy
   4. AIDs

1. Chlamydial ophthalmia
2. Chlamydial pneumonia
3. Trachoma
   1. Corneal scarring and blindness

1. Replication

1. Infection

1. 1.Attachment
   1. OmpA binds heparan sulphate
2. 2.Entry
   1. T3SS injects TARP
      1. Induces uptake
3. 3.Primary differentiation
   1. EB to RB
4. 4.Cell division
   1. Rapid multiplication
5. 5.Effector secretion
   1. CPAF
      1. Degrade host TF's
   2. Chronic inflammatory response
6. 6.Secondary differentiation
   1. RB to EB (Intermediate form)
   2. Chromosomal condensation
   3. OMC formation
   4. T3SS formation
7. 7.EB release

1. Vaginal discharge
2. Abdominal pain
3. Burning pee
   1. Urinal ouchy pee pee times
4. PID

1. Burning pee pee
2. Pus discharge
3. Epididymitis

1. Gonoccocal opthalmia

Nota:

• Vancomcin, inhibits gram positive Colistin, inhibits most gram neg

1. Inhibits most others

1. Type 4
   1. T2SS
      1. Transformation
         1. DNA binding
         2. Uptake
         3. RecA mediated recombination
   2. Binds CR3 and CD46

1. Opa proteins
   1. OpaHS
      1. Binds heparin sulphate
   2. OpaCEA
      1. Binds CEACAM
         1. Uptake

1. Recombination
   1. Transformation
   2. Gene exchange
2. Antigenic variation
   1. Abberant recombination
      1. L-pilin
         1. PilS and PilE unequal exchange
         2. Stuck in periplasm
         3. Evades immune system recognition
      2. S-pilin
         1. Secreted soluble pilin molecular decoy
   2. PilE and PilS exchange
      1. E for expressed
      2. Genetic recombination between homologous segments
3. Phase variation
   1. Homopolymeric repeats
   2. Tetranucleotide repeats
   3. PilC
      1. 11-12G = off
      2. <11->12 = on
   4. CTTCT repeats
      1. 3,6,9,12 = on
      2. Opa proteins
4. Sialylated lipopolysaccharide
   1. Resistant to complement and antibodies
   2. Mimics host cell surface