Title: T4 / BV6 / Modul 5 / Bakteriella STIs

Q: Can syphilis, gonorrhoea, chlamydia and trichomoniasis be cured?
A: All of them are curable

Q: WHich anatomical sites can be affected by STIs?
A: Can affect genital and extragenital sites

Q: What is the primary mode of transmission of STIs?
A: Sexual transmission

Q: What is the secondary mode of transmission of STIs?
A: - Vertical transmission
- Blood products, organ donations (syphilis)

Q: Vilken var den främsta STI:n innan HIV?
A: Syfilis

Q: Where globally are most cases of syphilis?
A: Moste cases are now in the african region

Q: What does the incidense of syphilis look like in sve?
A: - Few cases in women, mostly a disease for men
- Among men  - men having sex with men is the main target group for syphilis

How contagious is syphilis?

What is the incubation time of syphilis?

How is syphilis transmitted?

Q: What is the bacterium causing syphilis called?
A: Treponema pallidum

Q: How does syphilis develop after infection/inoculation?
A: 1. Inoculation, it takes a while for symtomes to appear
2. When symtomes (one ulceration) occurs its primary syphilis
3. Asymtomatic incubation period, during these 20 weeks u develop secondary syphilis, this is when they develop more severe symtomes
4. Latent can last between 3-20 years
5. About 30% of untreated patients will get symtomes again that are more severe -> tertiary syphilis -> associated with cardiovascular and neuro-syphilis

Q: What treamtment do people with syphilis require?
A: People with syphilis need antibiotics, still sensitive to them

Q: When does a congenital infection with syphilis occur?
A: - At the time of delivert but mostly in utero transmission
- Pregnant women with secondary syphilis

Q: When does syphilis cross the placenta?
A: - It can cross the placenta and be in the umbilical cord
- Transplacental passage as early as 9 weeks of gestation

Q: What happens if congenital syphilis is left untreated?
A: - 40% of infants will have invasion of the CNS
- Syphilis is the 2nd leading cause of stillborn children

How can treponema pallidum be described?

What does treponema pallidum look like?

How can syphilis (treponema pallidum) not be detected?

Q: Where does syphilis reside in the host?
A: - It is an intracellular pathogen
- Only host know is human

WHich virulence factors does syphilis have?

Q: Where is the flagellum of syphilis attached?
A: The flagellum is anchored to the cell - cytoplasmic membrane

Q: What are many of the membrane structures of treponema pallidum?
A: - A lot of them are lipoproteins - important for interaction between the host cell and the fibronectin
- All of the proteins have several functions in this bacterium

Q: What are TPR's in the membrane of syphilis used for?
A: TPR required to get the nutrients in the bacteria
- Antigenic variation of these proteins is in the loops exposed to the surface - they vary/modify
- This protein is variable - when this is exposed on the surface it's never the same and the immune system cannot recognize it

Q: How can adhesion with treponema pallidum be described in steps?
A: 1. ECM binding
2. Endothelial cell receptor binding
3. Extravasation
The bacteria goes inbetween the cells

Q: What is syphilis plan for immune evasion?
A: - The stategy is being hidden from the immune system
- It's elongated shape makes it hard for the immune system to detect

Q: What type of inflammation do we get from syphilis?
A: One only get local inflammation, rarely systemic inflammation

Q: What is a dangerous combination with syphilis?
A: - Syphilis + HIV
- Treponema pallidum is a re-emerging disease

How is syphilis and HIV a bad combo?

Q: How does HIV affect syphilis?
A: - Increases inflammation and load of viruses in the body - HIV
- Higher risk of developing more severe symtomes - with a dual infection

Q: How is syphilis treated?
A: Penicillin G (emergence of azithromycin resistance)

Q: Why don't we have many cases of secondary syphilis?
A: - We don't see many secondary syphilis infections because people have prolly taken antibiotics for other reasons that likely killed the syphilis bacteria in the process
- Syphilis is sensitive to antibiotics

How can chlamydia trachomatis be described?

Q: What does chlamydia depend on?
A: Chalmydia depends completely on host metabolism

Q: What does chlamydia do to itself?
A: - Removes what it doesnt need in its host cell - small bacteria
- Since chalmydia is simplifed, the serotype is determined on composition of proteins in the outer membrane

Q: What does chlamydias serotype depend on?
A: The serotype is determined based on composition of proteins in the outer membrane

Which chlamydia serotypes exist?

What are the signs of chlamydia in women?

What are the signs of chlamydia in men?

How is chlamydia diagnosed in women?

Q: How is chlamydia diagnosed in men?
A: First catch urine sample or urethral swab

Q: How can chlamydia's cycle be described step by step?
A: 1. Chlamydia will interact with the surface of the cell (chlamydia, adhesion, heparansulfat -> these 3 intercat with the rec)
2. When this is done chlamydia will be internalised - happens by secreting factors that trigger internalisation
3. Chlamydia has T3SS and its virulence factors - used to secrete virulens factors - the bcateria will secrete virlense factors and the inclusionbody will be formed
4. Next it will prevent fusion of inclusion body with the lysosome, the bacteria will metabolically transfrom from elementray body to reticular body
5. The inclusion body becomes bigger and chlamydia multiplies and acquires all nutrients needed
6. When the inclusion body becomes too tight for the bacteria it's a trigger for chlamydia to revert to elementray body - some will stay as reticular and some become elementary
7. When this goes back to elementray more virulence factors will be secretetd and the cell will lysate and bacteria will be released in the body and a new cycle will start

Q: In which forms can chlamydia be found?
A: Chlamydia comes in 2 forms, as an elementary body and as a reticular body - both are metabolically active but have different purposes

Q: What is the purpose of the elementary and reticular bodies respectively?
A: - In the elementary body the chalmydia is trying to survive and infect
- Reticular is intracellular and wants to multiply and acquire nutrients

Q: What will happen with inclusion body if the cell is stressed?
A: - If the cells are stressed in the inclusion body, it will go into a persistant inclusion-body-form
- Bacteria will be less metabolically active till the conditions are better and then continue the cycle

Q: What does the TarP do for chlamydia (host interactions)?
A: - TarP will in the host cell be fosforylated and trigger a cascade of host cell porteins
- The cell will survive even though apoptosis is turned on
- TarP rearrange the actine filaments so chlamydia can be internalised

Q: How else can chlamydia affect the host cell (host interactions)?
A: - Chlamydia will secrete inc-proteins (membrane of inclusion body)
- These proteins will recruit host proteins that will reroute the metabolism of the whole cell
- This recruits all the proteins chlamydia needs, will allow it to get all the vesicles from the golgi and the nutrients they contain

Q: How does chlamydia acquire lipids?
A: - Chlamydia also needs lipids and other nutrients
- One of the Inc-proteins will interact directly with lipid droplets that can be internalised and used by chlamydia
- Inc proteins can interact with various proteins form the host cell

Q: What do Inc proteins do?
A: Inc proteins can interact with various proteins form the host cell

Q: What "weapon" does chlamydia have?
A: T3SS

Q: What is the T3SS?
A: - Complexes in the inner and outer membranes, there is a needle with a pore that infects the host membrane - they create a channel for effector proteins between the cytoplasm of bacteria to cytoplasm of hostcell
- This machinery is connected to flagellum machinery

Q: Which STI is the main one causing STIs?
A: Gonorrhoea