The zwitterionic phospho-forms phosphoethanolamine and phosphocholine are recognized as influential and important substituents of pathogen cell surfaces. PilE, the major pilin subunit protein of the type IV pilus (Tfp) colonization factor of Neisseria gonorrhoeae undergoes unique, post-translational modifications with these moieties. These phospho-form modifications have been shown to be O-linked alternately to a specific, conserved serine residue of PilE. However, the enzymes and precursors involved in their addition are unknown, and the full spectrum of PilE posttranslational modifications has yet to be defined. Here, an intact protein-based mass spectrometric approach was integrated with bioinformatics and reverse genetics to address these matters. Specifically we show that a protein limited in its distribution to pathogenic Neisseria species and structurally related to enzymes implicated in phosphoethanolamine modification of lipopolysaccharide is necessary for PilE covalent modification with phosphoethanolamine and phosphocholine. These findings strongly suggest that protein phospho-form modification is mechanistically similar to processes underlying analogous modifications of prokaryotic saccharolipid glycans. We also show that PilE undergoes multisite and hierarchical phospho-form modifications and that the stoichiometries of site occupancy can be influenced by PilE primary structure and the abundance of the pilin-like protein PilV. Together, these findings have important implications for the structure and antigenicity of PilE.Covalent post-translational modifications of surface proteins in microbial pathogens are now a well established phenomenon. By modifying structure and potentially function, such post-translational modifications are likely to play an important role in the parasite-host interaction. Moreover, post-translational modifications provide effective means to augment the information content of compact genomes, to generate diversity, and to influence antigenicity. By way of example, covalent protein modifications with N-and O-linked carbohydrate appear more and more as common features of proteins of bacterial pathogens (1). Studies have revealed a surprisingly high degree of conservation and relatedness in a number of these systems, and in some instances glycosylation-defective mutants have been shown to be attenuated in virulence-associated properties (2, 3) and colonization (4 -7). Nonetheless, the full significance of protein glycosylation has yet to be precisely defined in any prokaryotic system. Type IV pili (Tfp) 4 are proteinaceous polymeric filaments that serve critical roles in disease pathogenesis and prokaryotic cell biology in many Gram-negative species. Important human pathogens expressing Tfp include Neisseria gonorrhoeae, Neisseria meningitidis, Vibrio cholerae, Pseudomonas aeruginosa, and enteropathogenic strains of Escherichia coli (8). Tfp contribute to colonization by virtue of promoting binding to epithelial cells, motility-generating capacity, and the ability to aggregate ...