Chapter 11 : Gender Differences in Pathogenesis

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Today, infections attributed to continue to be a national and international problem, despite the fact that antibiotic therapy is available. This chapter attempts to contrast the different mechanisms of pathogenesis used by to infect, to invade, and to colonize the mucosal epithelia of the urethra and the uterine cervix, the initial sites of infection in males and females, respectively. Included among the better-studied outer membrane gonococcal constituents contributing to its virulence are pili, porin, the opacity-associated (Opa) outer membrane proteins, and lipooligosaccharide (LOS). Work by many researchers has revealed additional factors that may contribute to virulence; however, the roles of these factors in human disease are less well defined than those described for pili, porin, Opa proteins, and LOS. Before the 1970s, the understanding of gonococcal pathogenesis in the lower female genital tract was based on light microscopy studies performed by Harkness in the 1940s. The male urethra and the female uterine cervix, the primary sites of the majority of gonococcal infections, are distinctly different epithelial cell surfaces, which result from different embryological origins. While the importance of virulence factors such as pili, porin, Opa, and LOS in gonococcal infection both in vitro and in vivo is well established, the contribution of other virulence factors is undetermined or requires further elucidation.

Citation: Edwards J. 2007. Gender Differences in Pathogenesis, p 149-173. In Brogden K, Minion F, Cornick N, Stanton T, Zhang Q, Nolan L, Wannemuehler M (ed), Virulence Mechanisms of Bacterial Pathogens, Fourth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555815851.ch11
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Image of FIGURE 1

The intimate association of gonococcal and male urethral epithelial cell membranes is visible in both panels. (A) Transmission electron micrograph of a urethral epithelial cell within a urethral exudate obtained from a man with naturally acquired gonococcal urethritis. Gonococci are denoted by arrows. Note the tight vacuole surrounding the intracellular organism (large arrow). (B) Scanning electron micrograph of primary male urethral epithelial cells after infection with gonococci. Magnification: panel A, ×23,000; panel B, ×40,000. Reprinted from ( ).

Citation: Edwards J. 2007. Gender Differences in Pathogenesis, p 149-173. In Brogden K, Minion F, Cornick N, Stanton T, Zhang Q, Nolan L, Wannemuehler M (ed), Virulence Mechanisms of Bacterial Pathogens, Fourth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555815851.ch11
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Image of FIGURE 2

Electron microscopy demonstrates that membrane ruffling and macropinocytosis occur upon cervical infection in vitro and in vivo. (A) Scanning electron micrograph of a membrane ruffle after a 90-min infection of primary cervical epithelial cells. Arrows highlight a gonococcus cell engulfed within membrane folds of the ruffle. (B to D) Transmission electron micrographs revealing large membrane protrusions (small arrows) and the presence of gonococci in spacious vacuoles (large arrows), suggestive of membrane ruffling and macropinocytosis, respectively. (B) Gonococcal infection of primary cervical epithelial cells results in gonococcus internalization within spacious, actin-lined vacuoles. (C and D) Large membrane protrusions engulf gonococci in a clinical biopsy sample obtained from a woman with culture-documented gonococcal cervicitis (C) and in a culture of primary cervical epithelial cells 3 h postinfection (D). Magnification: panel A, ×11,000; panel B, ×22,000; panels C and D, ×40,000. Panels A and C are reprinted from ( ) and panels B and D are reprinted from ( ).

Citation: Edwards J. 2007. Gender Differences in Pathogenesis, p 149-173. In Brogden K, Minion F, Cornick N, Stanton T, Zhang Q, Nolan L, Wannemuehler M (ed), Virulence Mechanisms of Bacterial Pathogens, Fourth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555815851.ch11
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