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Gonococcal Infections
This web page is archived for historical purposes and is no longer being updated. Newer content is available at www.cdc.gov/std/treatment
- Update to CDC's Sexually Transmitted Diseases Treatment 2010 Guidelines: Oral Cephalosporins No Longer a Recommended Treatment for Gonococcal Infections - MMWR August 10, 2012
- Cephalosporin-Resistant Neisseria Gonorrhoeae Public Health Response Plan Offers guidance state and local health departments can take to keep a watchful eye on the emergence of drug resistance. (August 9, 2012)
Gonococcal Infections in Adolescents and Adults
In the United States, an estimated 700,000 new N. gonorrhoeae infections occur each year (93,293). Gonorrhea is the second most commonly reported bacterial STD. The majority of urethral infections caused by N. gonorrhoeae among men produce symptoms that cause them to seek curative treatment soon enough to prevent serious sequelae, but treatment might not be soon enough to prevent transmission to others. Among women, gonococcal infections might not produce recognizable symptoms until complications (e.g., PID) have occurred. PID can result in tubal scarring that can lead to infertility or ectopic pregnancy.
The prevalence of gonorrhea varies widely among communities and populations; health-care providers should consider local gonorrhea epidemiology when making screening decisions. Although widespread screening is not recommended because gonococcal infections among women are frequently asymptomatic, targeted screening of young women (i.e., those aged <25 years) at increased risk for infection is a primary component of gonorrhea control in the United States. For sexually active women, including those who are pregnant, USPSTF (82) recommends that clinicians provide gonorrhea screening only to those at increased risk for infection (e.g., women with previous gonorrhea infection, other STDs, new or multiple sex partners, and inconsistent condom use; those who engage in commercial sex work and drug use; women in certain demographic groups; and those living in communities with a high prevalence of disease). USPSTF does not recommend screening for gonorrhea in men and women who are at low risk for infection (82).
Diagnostic Considerations
Because of its high specificity (>99%) and sensitivity (>95%), a Gram stain of a male urethral specimen that demonstrates polymorphonuclear leukocytes with intracellular Gram-negative diplococci can be considered diagnostic for infection with N. gonorrhoeae in symptomatic men. However, because of lower sensitivity, a negative Gram stain should not be considered sufficient for ruling out infection in asymptomatic men. In addition, Gram stain of endocervical specimens, pharyngeal, or rectal specimens also are not sufficient to detect infection, and therefore are not recommended. Specific testing for N. gonorrhoeae is recommended because of the increased utility and availability of highly sensitive and specific testing methods and because a specific diagnosis might enhance partner notification.
Specific diagnosis of infection with N. gonorrhoeae can be performed by testing endocervical, vaginal, urethral (men only), or urine specimens. Culture, nucleic acid hybridization tests, and NAATs are available for the detection of genitourinary infection with N. gonorrhoeae (197). Culture and nucleic acid hybridization tests require female endocervical or male urethral swab specimens. NAATs allow testing of the widest variety of specimen types including endocervical swabs, vaginal swabs, urethral swabs (men), and urine (from both men and women), and they are FDA-cleared for use. However, product inserts for each NAAT vendor must be carefully examined, because specimen types that are FDA-cleared for use vary by test. NAAT tests are not FDA-cleared for use in the rectum, pharynx, and conjunctiva; however, some public and private laboratories have established performance specifications for using NAAT with rectal and pharyngeal swab specimens, thereby allowing results to be used for clinical management. Laboratories that establish performance specifications for the use of NAATs with nongenital specimens must ensure that specificity is not compromised by cross-reaction with nongonococcal Neisseria species. The sensitivity of NAATs for the detection of N. gonorrhoeae in genital and nongenital anatomic sites is superior to culture but varies by NAAT type (197,278-281).
Because nonculture tests cannot provide antimicrobial susceptibility results, in cases of suspected or documented treatment failure, clinicians should perform both culture and antimicrobial susceptibility testing.
All persons found to have who have gonorrhea also should be tested for other STDs, including chlamydia, syphilis, and HIV.
Dual Therapy for Gonococcal and Chlamydial Infections
Patients infected with N. gonorrhoeae frequently are coinfected with C. trachomatis; this finding has led to the recommendation that patients treated for gonococcal infection also be treated routinely with a regimen that is effective against uncomplicated genital C. trachomatis infection (294). Because most gonococci in the United States are susceptible to doxycycline and azithromycin, routine cotreatment might also hinder the development of antimicrobial-resistant N. gonorrhoeae. Limited data suggest that dual treatment with azithromycin might enhance treatment efficacy for pharyngeal infection when using oral cephalosporins (295,296).
Antimicrobial-Resistant N. gonorrhoeae
Gonorrhea treatment is complicated by the ability of N. gonorrhoeae to develop resistance to antimicrobial therapies (297). Quinolone-resistant N. gonorrhoeae strains are now widely disseminated throughout the United States and the world (298). As of April 2007, quinolones are no longer recommended in the United States for the treatment of gonorrhea and associated conditions, such as PID (299). Consequently, only one class of antimicrobials, the cephalosporins, is recommended and available for the treatment of gonorrhea in the United States. The CDC website (/std/gisp) and state health departments can provide the most current information.
The proportion of isolates in CDC's Gonococcal Isolate Surveillance Project (GISP) demonstrating decreased susceptibility to ceftriaxone or cefixime has remained very low over time; during 1987–2008, only four isolates were found to have decreased susceptibility to ceftriaxone, and 48 isolates had decreased susceptibility to cefixime. In 2008, no isolates demonstrated decreased susceptibility to ceftriaxone; cefixime was not part of test panel during that year (93). Although only two cases of suspected treatment failure with ceftriaxone have been reported (300), approximately 50 patients are thought to have failed oral cephalosporin treatment (301-304).
Most of the treatment failures resulting from use of oral cephalosporins have been reported from Asian countries, although one possible case was reported in Hawaii in 2001 (305). To ensure appropriate antibiotic therapy, clinicians should ask patients testing positive for gonorrhea about recent travel to and sexual activity in these countries.
Decreased susceptibility of N. gonorrhoeae to cephalosporins and other antimicrobials is expected to continue to spread; therefore, state and local surveillance for antimicrobial resistance is crucial for guiding local therapy recommendations (297). GISP, which samples approximately 3% of all U.S. men who have gonococcal infections, is a mainstay of surveillance. However, surveillance by clinicians also is critical. Clinicians who diagnose N. gonorrhoeae infection in a patient with suspected cephalosporin treatment failure should perform culture and susceptibility testing of relevant clinical specimens, consult a specialist for guidance in clinical management, and report the case to CDC through state and local public health authorities. Health departments should prioritize partner notification and contact tracing of patients with N. gonorrhoeae infection thought to be associated with cephalosporin treatment failure or associated with patients whose isolates demonstrate decreased susceptibility to cephalosporin.
Uncomplicated Gonococcal Infections of the Cervix, Urethra, and Rectum
NOTE: See Update to CDC's Sexually Transmitted Diseases Treatment 2010 Guidelines: Oral Cephalosporins No Longer a Recommended Treatment for Gonococcal Infections
The current regimen is listed below.
Recommended Regimens
Ceftriaxone 250 mg in a single intramuscular dose
Azithromycin 1 g orally in a single dose
Doxycycline 100 mg orally twice a day for 7 days*
Alternative regimens
If ceftriaxone is not available:
Cefixime 400 mg in a single oral dose
Azithromycin 1 g orally in a single dose
or doxycycline 100 mg orally twice daily for 7 days*
Test-of-cure in 1 week
If the patient has severe cephalosporin allergy:
Azithromycin 2 g in a single oral dose
Test-of-cure in 1 week
* Because of the high prevalence of tetracycline resistance among Gonococcal Isolate Surveillance Project isolates, particularly those with elevated minimum inhibitory concentrations to cefixime, the use of azithromycin as the second antimicrobial is preferred.
To maximize compliance with recommended therapies, medications for gonococcal infections should be dispensed on site. Ceftriaxone in a single injection of 250 mg provides sustained, high bactericidal levels in the blood. Extensive clinical experience indicates that ceftriaxone is safe and effective for the treatment of uncomplicated gonorrhea at all anatomic sites, curing 99.2% of uncomplicated urogenital and anorectal and 98.9% of pharyngeal infections in published clinical trials (306,307). A 250-mg dose of ceftriaxone is now recommended over a 125-mg dose given the 1) increasingly wide geographic distribution of isolates demonstrating decreased susceptibility to cephalosporins in vitro, 2) reports of ceftriaxone treatment failures, 3) improved efficacy of ceftriaxone 250 mg in pharyngeal infection (which is often unrecognized), and 4) the utility of having a simple and consistent recommendation for treatment regardless of the anatomic site involved.
A 400-mg oral dose of cefixime does not provide as high, nor as sustained, a bactericidal level as that provided by the 250-mg dose of ceftriaxone. In published clinical trials, the 400-mg dose cured 97.5% of uncomplicated urogenital and anorectal (95% CI = 95.4%–99.8%) and 92.3% of pharyngeal gonococcal infections (95% CI = 74.9%–99.1%) (306,307). Although cefixime can be administered orally, this advantage is offset by the limited efficacy of cefixime (as well as other oral cephalosporins) for treating gonococcal infections of the pharynx. Providers should inquire about oral sexual exposure and if reported, treat these patients with ceftriaxone because of this drug's well documented efficacy in treating pharyngeal infection.
Single-dose injectable cephalosporin regimens (other than ceftriaxone 250 mg IM) that are safe and highly effective against uncomplicated urogenital and anorectal gonococcal infections include ceftizoxime (500 mg, administered IM), cefoxitin (2 g, administered IM with probenecid 1 g orally), and cefotaxime (500 mg, administered IM). None of the injectable cephalosporins offer any advantage over ceftriaxone for urogenital infection, and efficacy for pharyngeal infection is less certain (306,307).
Alternative Regimens
Several other antimicrobials are active against N. gonorrhoeae, but none have substantial advantages over the recommended regimens, and they should not be used if pharyngeal infection is suspected. Some evidence suggests that cefpodoxime 400-mg orally can be considered an alternative in the treatment of uncomplicated urogenital gonorrhea; this regimen meets the minimum efficacy criteria for alternative regimens for urogenital infection (demonstrated efficacy of ≥95% in clinical trials with lower 95% CI of >90%) (307). In one clinical trial, cefpodoxime 400 mg orally was found to have a urogenital and rectal cure rate of 96.6% (95% CI = 93.9%), but the efficacy of cefpodoxime 400 mg orally at the pharyngeal site was poor (70.3%, 95% CI = 53.0%) (Hall, unpublished data, 2010). Gonococcal strains with decreased susceptibility to oral cephalosporins have been reported in the United States (308). With a cure rate of 96.5% (95% CI = 93.6%–98.3%) for urogenital and rectal infection, cefpodoxime proxetil 200 mg orally meets the criteria for an alternative regimen; however, its use is not advised because of concerns about the pharmacodynamics of cefpodoxime using this dose. Efficacy in treating pharyngeal infection with cefpodoxime 200 mg is unsatisfactory (78.9%; 95% CI = 54.5%–94%), as with cefpodoxime at the 400-mg dose.
Treatment with cefuroxime axetil 1 g orally meets the criteria for minimum efficacy as an alternative regimen for urogenital and rectal infection (95.9%; 95% CI = 94.3%–97.2%), but the pharmacodynamics of cefuroxime axetil 1 g orally are less favorable than those of cefpodoxime 400 mg, cefixime 400 mg, or ceftriaxone 125 mg (309). The efficacy of cefuroxime axetil 1 g orally in treating pharyngeal infection is poor (56.9%; 95% CI = 42.2%–70.7%).
Spectinomycin, which is useful in persons who cannot tolerate cephalosporins, is expensive, must be injected, and is not available in the United States (updates available at: www.cdc.gov/std/treatment) (310). However, it has been effective in published clinical trials, curing 98.2% of uncomplicated urogenital and anorectal gonococcal infections. Spectinomycin has poor efficacy against pharyngeal infection (51.8%; 95% CI = 38.7%–64.9%) (306).
Azithromycin 2 g orally is effective against uncomplicated gonococcal infection (99.2%; 95% CI = 97.3%–99.9%), but concerns over the ease with which N. gonorrhoeae can develop resistance to macrolides should restrict its use to limited circumstances. Although azithromycin 1 g meets alternative regimen criteria (97.6%; 95% CI = 95.7%–98.9%), it is not recommended because several studies have documented treatment failures, and concerns about possible rapid emergence of antimicrobial resistance with the 1-g dose of azithromycin are even greater than with the 2-g dose (311–313). N. gonorrhoeae in the United States is not adequately susceptible to penicillins, tetracyclines, and older macrolides (e.g., erythromycin) for these antimicrobials to be recommended.
Uncomplicated Gonococcal Infections of the Pharynx
Most gonococcal infections of the pharynx are asymptomatic and can be relatively common in some populations (103,278,279,314). Gonococcal infections of the pharynx are more difficult to eradicate than infections at urogenital and anorectal sites (315). Few antimicrobial regimens, including those involving oral cephalosporins, can reliably cure >90% of gonococcal pharyngeal infections (306,307). Providers should ask their patients about oral sexual exposure; if reported, patients should be treated with a regimen with acceptable efficacy against pharyngeal infection. Chlamydial coinfection of the pharynx is unusual; however, because coinfection at genital sites sometimes occurs, treatment for both gonorrhea and chlamydia is recommended.
NOTE: See Update to CDC's Sexually Transmitted Diseases Treatment 2010 Guidelines: Oral Cephalosporins No Longer a Recommended Treatment for Gonococcal Infections
The current regimen is listed below.
Recommended Regimens
Ceftriaxone 250 mg in a single intramuscular dose
Azithromycin 1 g orally in a single dose
or doxycycline 100 mg orally twice daily for 7 days*
* Because of the high prevalence of tetracycline resistance among Gonococcal Isolate Surveillance Project isolates, particularly those with elevated minimum inhibitory concentrations to cefixime, the use of azithromycin as the second antimicrobial is preferred.
Patients diagnosed with uncomplicated gonorrhea who are treated with any of the recommended or alternative regimens do not need a test-of-cure (i.e., repeat testing 3-4 weeks after completing therapy). Patients who have symptoms that persist after treatment should be evaluated by culture for N. gonorrhoeae, and any gonococci isolated should be tested for antimicrobial susceptibility. Persistent urethritis, cervicitis, or proctitis also might be caused by C. trachomatis or other organisms.
N. gonorrhoeae infection is prevalent among patients who have been diagnosed with and treated for gonorrhea in the preceding several months (64,251,252,267). Most infections result from reinfection rather than treatment failure, indicating a need for improved patient education and referral of sex partners. Clinicians should advise patients with gonorrhea to be retested 3 months after treatment. If patients do not seek medical care for retesting in 3 months, providers are encouraged to test these patients whenever they next seek medical care within the following 12 months, regardless of whether the patients believe that their sex partners were treated. Retesting is distinct from test-of-cure to detect therapeutic failure, which is not recommended.
Management of Sex Partners
Effective clinical management of patients with treatable STDs requires treatment of the patients' recent sex partners to prevent reinfection and curtail further transmission. Patients should be instructed to refer their sex partners for evaluation and treatment. Sex partners of patients with N. gonorrhoeae infection whose last sexual contact with the patient was within 60 days before onset of symptoms or diagnosis of infection in the patient should be evaluated and treated for N. gonorrhoeae and C. trachomatis infections. If a patient's last sexual intercourse was >60 days before onset of symptoms or diagnosis, the patient's most recent sex partner should be treated. Patients should be instructed to abstain from sexual intercourse until therapy is completed and until they and their sex partners no longer have symptoms.
For heterosexual patients with gonorrhea whose partners' treatment cannot be ensured or is unlikely, delivery of antibiotic therapy for gonorrhea (as well as for chlamydia) by the patients to their partners can be considered (see Partner Management). Use of this approach (68,71) should always be accompanied by efforts to educate partners about symptoms and to encourage partners to seek clinical evaluation. For male patients informing female partners, educational materials should include information about the importance of seeking medical evaluation for PID (especially if symptomatic). Possible undertreatment of PID in female partners and possible missed opportunities to diagnose other STDs are of concern and have not been evaluated in comparison with patient-delivered therapy and partner referral. This approach should not be considered a routine partner management strategy in MSM because of the high risk for coexisting undiagnosed STDs or HIV infection.
Special Considerations
Allergy, Intolerance, and Adverse Reactions
Reactions to first generation cephalosporins occur in approximately 5%–10% of persons with a history of penicillin allergy and occur less frequently with third-generation cephalosporins (239). In those persons with a history of penicillin allergy, the use of cephalosporins should be contraindicated only in those with a history of a severe reaction to penicillin (e.g., anaphylaxis, Stevens Johnson syndrome, and toxic epidermal necrolysis) (316).
Because data are limited regarding alternative regimens for treating gonorrhea among persons who have severe cephalosporin allergy, providers treating such patients should consult infectious disease specialists. Azithromycin 2 g orally is effective against uncomplicated gonococcal infection, but because of concerns over emerging antimicrobial resistance to macrolides, its use should be limited. Cephalosporin treatment following desensitization is impractical in most clinical settings.
As with other patients, pregnant women infected with N. gonorrhoeae should be treated with a recommended or alternate cephalosporin. Because spectinomycin is not available in the United States, azithromycin 2 g orally can be considered for women who cannot tolerate a cephalosporin. Either azithromycin or amoxicillin is recommended for treatment of presumptive or diagnosed C. trachomatis infection during pregnancy (see Chlamydial Infections).
HIV Infection
Patients who have gonococcal infection and also are infected with HIV should receive the same treatment regimen as those who are HIV negative.
Suspected Cephalosporin Treatment Failure or Resistance
Suspected treatment failure has been reported among persons receiving oral and injectable cephalosporins (300-304). Therefore, clinicians of patients with suspected treatment failure or persons infected with a strain found to demonstrate in vitro resistance should consult an infectious disease specialist, conduct culture and susceptibility testing of relevant clinical specimens, retreat with at least 250 mg of ceftriaxone IM or IV, ensure partner treatment, and report the situation to CDC through state and local public health authorities.
Gonococcal Conjunctivitis
In the only published study of the treatment of gonococcal conjunctivitis among U.S. adults, all 12 study participants responded to a single 1-g IM injection of ceftriaxone (317).
Recommended Regimen
Ceftriaxone 1 g IM in a single dose
Consider lavage of the infected eye with saline solution once. Persons treated for gonococcal conjunctivitis should be treated presumptively for concurrent C. trachomatis infection.
Management of Sex Partners
Patients should be instructed to refer their sex partners for evaluation and treatment (see Gonococcal Infections, Management of Sex Partners).
Disseminated Gonococcal Infection (DGI)
DGI frequently results in petechial or pustular acral skin lesions, asymmetrical arthralgia, tenosynovitis, or septic arthritis. The infection is complicated occasionally by perihepatitis and rarely by endocarditis or meningitis. Some strains of N. gonorrhoeae that cause DGI can cause minimal genital inflammation. No recent studies have been published on the treatment of DGI.
Hospitalization is recommended for initial therapy, especially for patients who might not comply with treatment, for those in whom diagnosis is uncertain, and for those who have purulent synovial effusions or other complications. Examination for clinical evidence of endocarditis and meningitis should be performed. Persons treated for DGI should be treated presumptively for concurrent C. trachomatis infection.
Recommended Regimen
Ceftriaxone 1 g IM or IV every 24 hours
Alternative Regimens
Cefotaxime 1 g IV every 8 hours
Ceftizoxime 1 g IV every 8 hours
All of the preceding regimens should be continued for 24–48 hours after improvement begins, at which time therapy can be switched to cefixime 400 mg orally twice daily to complete at least 1 week of antimicrobial therapy. No treatment failures have been reported with the recommended regimens.
Management of Sex Partners
Gonococcal infection frequently is asymptomatic in sex partners of patients who have DGI. As with uncomplicated gonococcal infections, patients should be instructed to refer their sex partners for evaluation and treatment (see Gonococcal Infection, Management of Sex Partners).
Gonococcal Meningitis and Endocarditis
Recommended Regimen
Ceftriaxone 1–2 g IV every 12 hours
Therapy for meningitis should be continued for 10–14 days; therapy for endocarditis should be continued for at least 4 weeks. Treatment of complicated DGI should be undertaken in consultation with an infectious disease specialist.
Management of Sex Partners
Patients should be instructed to refer their sex partners for evaluation and treatment (see Gonococcal Infection, Management of Sex Partners).
Gonococcal Infections Among Infants
Gonococcal infection among infants usually is caused by exposure to infected cervical exudate at birth. It is usually an acute illness that manifests 2–5 days after birth. The prevalence of infection among infants depends on the prevalence of infection among pregnant women, whether pregnant women are screened for gonorrhea, and whether newborns receive ophthalmia prophylaxis. The most severe manifestations of N. gonorrhoeae infection in newborns are ophthalmia neonatorum and sepsis, which can include arthritis and meningitis. Less severe manifestations include rhinitis, vaginitis, urethritis, and reinfection at sites of fetal monitoring.
Ophthalmia Neonatorum Caused by N. gonorrhoeae
Although N. gonorrhoeae causes ophthalmia neonatorum relatively infrequently in the United States, identifying and treating this infection is especially important because ophthalmia neonatorum can result in perforation of the globe of the eye and blindness.
Diagnostic Considerations
Infants at increased risk for gonococcal ophthalmia are those who do not receive ophthalmia prophylaxis and those whose mothers have had no prenatal care or whose mothers have a history of STDs or substance abuse. Gonococcal ophthalmia is strongly suspected when intracellular gram-negative diplococci are identified in conjunctival exudate, justifying presumptive treatment for gonorrhea after appropriate cultures for N. gonorrhoeae are obtained. Appropriate chlamydial testing should be done simultaneously. Presumptive treatment for N. gonorrhoeae might be indicated for newborns who are at increased risk for gonococcal ophthalmia and who have increased WBCs (but not gonococci) in a Gram-stained smear of conjunctival exudate.
In all cases of neonatal conjunctivitis, conjunctival exudates should be cultured for N. gonorrhoeae and tested for antibiotic susceptibility before a definitive diagnosis is made. A definitive diagnosis is vital because of the public health and social consequences of a diagnosis of gonorrhea. Nongonococcal causes of neonatal ophthalmia include Moraxella catarrhalis and other Neisseria species, organisms that are indistinguishable from N. gonorrhoeae on Gram-stained smear but can be differentiated in the microbiology laboratory.
Recommended Regimen
Ceftriaxone 25–50 mg/kg IV or IM in a single dose, not to exceed 125 mg
Topical antibiotic therapy alone is inadequate and is unnecessary if systemic treatment is administered.
Other Management Considerations
Simultaneous infection with C. trachomatis should be considered when a patient does not improve after treatment. Both mother and infant should be tested for chlamydial infection at the same time that gonorrhea testing is conducted (see Ophthalmia Neonatorum Caused by C. trachomatis). Ceftriaxone should be administered cautiously to hyperbilirubinemic infants, especially those born prematurely.
Infants who have gonococcal ophthalmia should be hospitalized and evaluated for signs of disseminated infection (e.g., sepsis, arthritis, and meningitis). One dose of ceftriaxone is adequate therapy for gonococcal conjunctivitis.
Management of Mothers and Their Sex Partners
The mothers of infants who have gonococcal infection and the mothers' sex partners should be evaluated and treated according to the recommendations for treating gonococcal infections in adults (see Gonococcal Infections in Adolescents and Adults ).
DGI and Gonococcal Scalp Abscesses in Newborns
Sepsis, arthritis, and meningitis (or any combination of these conditions) are rare complications of neonatal gonococcal infection. Localized gonococcal infection of the scalp can result from fetal monitoring through scalp electrodes. Detection of gonococcal infection in neonates who have sepsis, arthritis, meningitis, or scalp abscesses requires cultures of blood, CSF, and joint aspirate on chocolate agar. Specimens obtained from the conjunctiva, vagina, oropharynx, and rectum that are cultured on gonococcal selective medium are useful for identifying the primary site(s) of infection, especially if inflammation is present. Positive Gram-stained smears of exudate, CSF, or joint aspirate provide a presumptive basis for initiating treatment for N. gonorrhoeae. Diagnoses based on Gram-stained smears or presumptive identification of cultures should be confirmed with definitive tests on culture isolates.
Recommended Regimens
Ceftriaxone 25–50 mg/kg/day IV or IM in a single daily dose for 7 days, with a duration of 10–14 days, if meningitis is documented
Cefotaxime 25 mg/kg IV or IM every 12 hours for 7 days, with a duration of 10–14 days, if meningitis is documented
Prophylactic Treatment for Infants Whose Mothers Have Gonococcal Infection
Infants born to mothers who have untreated gonorrhea are at high risk for infection.
Recommended Regimen in the Absence of Signs of Gonococcal Infection
Ceftriaxone 25–50 mg/kg IV or IM, not to exceed 125 mg, in a single dose
Other Management Considerations
Both mother and infant should be tested for chlamydial infection.
Follow-up examination is not required.
Management of Mothers and Their Sex Partners
The mothers of infants who have gonococcal infection and the mothers' sex partners should be evaluated and treated according to the recommendations for treatment of gonococcal infections in adults (see Gonococcal Infections).
Gonococcal Infections Among Children
Sexual abuse is the most frequent cause of gonococcal infection in preadolescent children (see Sexual Assault or Abuse of Children). For preadolescent girls, vaginitis is the most common manifestation of this infection; gonococcal-associated PID after vaginal infection is likely less common in preadolescents than adults. Among sexually abused children, anorectal and pharyngeal infections with N. gonorrhoeae are common and frequently asymptomatic.
Diagnostic Considerations
Because of the legal implications of a diagnosis of N. gonorrhoeae infection in a child, culture remains the preferred method for diagnosis. Gram stains are inadequate for evaluating prepubertal children for gonorrhea and should not be used to diagnose or exlude gonorrhea. NAATs for the detection of N. gonorrhoeae can be used under certain circumstances (see Sexual Assault or Abuse of Children)
Recommended Regimen for Children Who Weigh >45 kg
Treat with one of the regimens recommended for adults (see Gonococcal Infections)
Recommended Regimen for Children Who Weigh ≤45 kg and Who Have Uncomplicated Gonococcal Vulvovaginitis, Cervicitis, Urethritis, Pharyngitis, or Proctitis
Ceftriaxone 125 mg IM in a single dose
Recommended Regimen for Children Who Weigh ≤45 kg and Who Have Bacteremia or Arthritis
Ceftriaxone 50 mg/kg (maximum dose: 1 g) IM or IV in a single dose daily for 7 days
Recommended Regimen for Children Who Weigh >45 kg and Who Have Bacteremia or Arthritis
Ceftriaxone 50 mg/kg IM or IV in a single dose daily for 7 days
Follow-up cultures are unnecessary if ceftriaxone is used.
Other Management Considerations
Only parenteral cephalosporins (i.e., ceftriaxone) are recommended for use in children; cefotaxime is approved for gonococcal ophthalmia only. No data are available regarding the use of oral cefixime to treat gonococcal infections in children.
All children found to have gonococcal infections should be evaluated for coinfection with syphilis and C. trachomatis. (For a discussion of concerns regarding sexual assault, see Sexual Assault or Abuse of Children.)
Ophthalmia Neonatorum Prophylaxis
To prevent gonococcal ophthalmia neonatorum, a prophylactic agent should be instilled into the eyes of all newborn infants; this procedure is required by law in most states. All of the recommended prophylactic regimens in this section prevent gonococcal ophthalmia. However, the efficacy of these preparations in preventing chlamydial ophthalmia is less clear, and they do not eliminate nasopharyngeal colonization by C. trachomatis. The diagnosis and treatment of gonococcal and chlamydial infections in pregnant women is the best method for preventing neonatal gonococcal and chlamydial disease. Not all women, however, receive prenatal care, and therefore go untreated. Ocular prophylaxis is warranted for neonates, because it can prevent sight-threatening gonococcal ophthalmia and because it is safe, easy to administer, and inexpensive.
Recommended Regimen
Erythromycin (0.5%) ophthalmic ointment in each eye in a single application
This preparation should be instilled into both eyes of every neonate as soon as possible after delivery. Ideally, ointment should be applied using single-use tubes or ampules rather than multiple-use tubes. If prophylaxis is delayed (i.e., not administered in the delivery room), a monitoring system should be established to ensure that all infants receive prophylaxis. All infants should be administered ocular prophylaxis, regardless of whether they are delivered vaginally or by cesarean section.
Erythromycin is the only antibiotic ointment recommended for use in neonates. Silver nitrate and tetracycline ophthalmic ointment are no longer manufactured in the United States, bacitracin is not effective, and povidone iodine has not been studied adequately. If erythromycin ointment is not available, infants at risk for exposure to N. gonorrhoeae (especially those born to a mother with untreated gonococcal infection or who has received no prenatal care) can be administered ceftriaxone 25-50 mg/kg IV or IM, not to exceed 125 mg in a single dose.
- Page last reviewed: January 28, 2011 (archived document)
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That's the concept of "interest rate risk." Bonds rise and fall in value, in the opposite direction of interest rates. The longer the maturity of the bond, the bigger the potential swing in price. If you lock your money up for only three years, you might not worry so much. But if you're considering a 10-year bond, you have to consider the outlook for inflation and higher interest rates.
There's another risk in buying bonds: "quality risk," basically the risk that the borrower (either a company or government) won't be able to pay the interest in the years ahead, or repay the principal when the bond matures. That's why bonds carry ratings. The top-rated bonds — either from corporations or states and municipalities — carry ratings starting with AAA at the highest level. The lower the rating, the higher the rates they must pay to borrow. When buying tax-free state or local government "municipal bonds," consider the quality risk. The recession has slowed state tax revenues, while promises for education to pensions to prisons keep costing more. And the more states are hurting, the higher the interest rate they must pay to get you to lend them money by purchasing their bonds.
Before you jump at higher yields, ask yourself about the risks you're taking: either the risk that rates will rise and you'll be stuck, or the risk that comes with the nagging worry that your interest or principal payments might not be secure. There is always a risk when you earn more than the safest investments pay.

subset: commoncrawl


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Kate Gosselin might be one step closer to having to work a regular 9 – 5, as RadarOnline is reporting she has been axed from a new TV show that she shot a pilot for because the executives thought she was too controversial.
Kate shot the pilot for the show back in September. She was to be one of the several hosts for the Momlogic TV pilot. She joined Food Network star Paula Deen, Lee Woodruff and former Early Show co-host Rene Syler. The show, which has been described as The View for working moms (umm isn't The View for working moms as well?), is said to be on life support and will likely be canceled all together.
It is however still on schedule to be sold at the convention where TV shows are pitched, but an insider said there is little chance it will make it. A source close to the situation told Radar that the high-level executives believed Kate was too controversial for the show and didn't think she was ready for a full-time hosting job, even as part of a panel.
This unfortunately does not mark the end of Kate on television. As we reported earlier, TLC is developing a show for her, that should debut sometime in the spring. The concept of the show has yet to be made public, but TLC is reportedly very committed to the new show.


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A Neurosurgeon's Journey into the Afterlife
Proof of Heaven
A Neurosurgeon's Journey into the Afterlife
Thousands of people have had near-death experiences, but scientists have argued that they are impossible. Dr. Eben Alexander was one of those scientists. A highly trained neurosurgeon, Alexander knew that NDEs feel real, but are simply fantasies produced by brains under extreme stress.
Then, Dr. Alexander's own brain was attacked by a rare illness. The part of the brain that controls thought and emotion—and in essence makes us human—shut down completely. For seven days he lay in a coma. Then, as his doctors considered stopping treatment, Alexander's eyes popped open. He had come back.
Alexander's recovery is a medical miracle. But the real miracle of his story lies elsewhere. While his body lay in coma, Alexander journeyed beyond this world and encountered an angelic being who guided him into the deepest realms of super-physical existence. There he met, and spoke with, the Divine source of the universe itself.
Alexander's story is not a fantasy. Before he underwent his journey, he could not reconcile his knowledge of neuroscience with any belief in heaven, God, or the soul. Today Alexander is a doctor who believes that true health can be achieved only when we realize that God and the soul are real and that death is not the end of personal existence but only a transition.
This story would be remarkable no matter who it happened to. That it happened to Dr. Alexander makes it revolutionary. No scientist or person of faith will be able to ignore it. Reading it will change your life.
- Simon & Schuster |
- 208 pages |
- October 2012
Browse Related Books
Reading Group Guide
As a neurosurgeon schooled in some of the most elite institutions of the American scientific community, Dr. Eben Alexander considered himself an "unbeliever"—one who did not believe in God, Heaven or an afterlife. He was confident that the brain was the ultimate source of consciousness and all reports of experiences in the "spiritual realm" were unsupportable from a scientific perspective. Everything changed, though, on November 10, 2008, when a splitting headache landed him in an emergency room and ultimately a seven-day coma. In Proof of Heaven, Dr. Alexander recounts the story of those seven days and the spiritually transforming experience that occurred during them. When he awakened from his coma, his old certainties about the nonexistence of the afterlife were gone.
Topics & Questions for Discussion
1. Do you know anyone who had a Near Death Experience (NDE)? What was y see more


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GAINESVILLE, Fla. - The mayor of Gainesville has entered into a deferred prosecution agreement that resolves his DUI case.
The State Attorney's Office in Gainesville announced the agreement on Monday. According to the agreement, Craig Lowe will participate in a DUI Intervention Program, which is made available to first offenders with no significant criminal or traffic history.
The Gainesville Sun reports Lowe will be required to complete all requirements for those convicted of DUI. And he'll be monitored for 18 months and give up his driver's license for 14 days.
In a statement, Lowe said he accepts full responsibility for his March 21 DUI arrest, which he called "poor judgment." He says he will complete the program, which also includes 50 hours of community service and an alcohol evaluation.
Copyright 2013 by The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.


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You will learn
You will learn how to build the XSJS and XSODATA services used to expose your data model to the user interface. Although XS Advanced runs on Node.js, SAP has added modules to Node.js to provide XSJS and XSODATA backward compatibility. Therefore you can use the same programming model and much of the same APIs from the Extended Application Services, classic model even within this new environment.


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|MLB Career Stats
|19th in NL
|21st in NL
|May 21, 2014
|Chicago White Sox released 2B Jeff Keppinger.
|May 14, 2014
|Chicago White Sox designated 2B Jeff Keppinger for assignment.
|May 14, 2014
|Chicago White Sox activated 2B Jeff Keppinger from the 15-day disabled list.
|May 2, 2014
|Chicago White Sox sent 2B Jeff Keppinger on a rehab assignment to Birmingham Barons.
|March 30, 2014
|Chicago White Sox placed 2B Jeff Keppinger on the 15-day disabled list retroactive to March 21, 2014. Recovering from September 2013 right shoulder surgery
|December 10, 2012
|Chicago White Sox signed free agent 2B Jeff Keppinger.
|November 3, 2012
|2B Jeff Keppinger elected free agency.
|June 22, 2012
|Tampa Bay Rays activated 2B Jeff Keppinger from the 15-day disabled list.
|June 15, 2012
|sent 2B Jeff Keppinger on a rehab assignment to Durham Bulls.
|May 21, 2012
|Tampa Bay Rays placed 2B Jeff Keppinger on the 15-day disabled list retroactive to May 19, 2012. Broken right big toe.
|May 10, 2012
|Tampa Bay Rays activated 2B Jeff Keppinger from the restricted list.
|May 9, 2012
|Tampa Bay Rays placed 2B Jeff Keppinger on the restricted list.
|January 27, 2012
|Tampa Bay Rays signed free agent 2B Jeff Keppinger.
|December 12, 2011
|2B Jeff Keppinger elected free agency.
|July 19, 2011
|Houston Astros Traded 2B Jeff Keppinger to San Francisco Giants and Richmond Flying Squirrels Traded RHP Henry Sosa and RHP Jason Stoffel to Corpus Christi Hooks.
|May 27, 2011
|Jeff Keppinger roster status changed by Houston Astros.
|May 16, 2011
|Corpus Christi Hooks sent 2B Jeff Keppinger on a rehab assignment to Oklahoma City RedHawks.
|May 12, 2011
|Jeff Keppinger assigned to Corpus Christi Hooks.
|March 31, 2011
|Houston Astros placed 2B Jeff Keppinger on the 15-day disabled list retroactive to March 22, 2011. Recovering from January 2011 left foot surgery.
|September 1, 2010
|Houston Astros activated 2B Jeff Keppinger from the 15-day disabled list.
|August 29, 2010
|sent 2B Jeff Keppinger on a rehab assignment to Corpus Christi Hooks.
|August 20, 2010
|Houston Astros placed 2B Jeff Keppinger on the 15-day disabled list retroactive to August 17, 2010. Fractured left big toe.
Has two children: Kaden and Brilee … Twitter: @JKeppinger … attended the University of Georgia, where he hit .380 during his three-year career … hit .389 with 18 home runs and 73 RBI during his junior season to lead Georgia to a berth in the College World Series … went 4-9 (.444) at the CWS, including a triple and two-run homer off Southern California's Mark Prior … was named a Baseball America and Louisville Slugger first-team freshman All-American … is a 1998 graduate of Parkview (Ga.) High School.2013
Appeared in 117 games in his first season with Chicago, his most since 2010 (137) … played 45 games at second base (41 starts), 41 at third (35), 20 at first (14) and 15 as the designated hitter (13) … his .253 average was a career-low, and his 41 strikeouts a career high … batted .287 (84-293) in 86 games from 5/15-remainder of the season … his .214 (22-103) average vs. left-handers was down from .376 in 2012 and .333 over his career entering the season … went 19-56 (.339) as the DH and 16-51 (.314) with 16 RBI with RISP/two outs … was 1-4 in his White Sox debut as the starting third baseman on Opening Day vs. Kansas City … went hitless over a career-high 24 at-bats from 4/15-22 … recorded three consecutive multihit games for the first time in his career from 4/22-25 … drew a game-winning, bases-loaded walk in the ninth inning on 5/16 at Los Angeles-AL … the walk was his first of the season, snapping a streak of 139 plate appearances without a walk … hit his first homer with the White Sox on 5/21 vs. Boston and a game-ending single in the 11th inning on 5/24 vs. Miami … compiled an eight-game hitting streak from 5/29-6/10 (.324, 11-34) … registered his first three-hit game of the season on 5/29 at the Cubs … reached base four times on 6/22 at Kansas City … was 6-8 with a triple, homer and four RBI in a doubleheader on 6/28 vs. Cleveland … posted four multihit games in a seven-game span from 8/12-18 (.400, 10-25) … hit his third home run on 8/16 at Minnesota, snapping a 139 at-bat homerless streak dating back to 6/28-1 vs. Cleveland … hit safely in his final six games from 9/8-23 (.429, 9-23) … underwent season-ending surgery to debride his right shoulder on 9/26.2012 Established a career high with nine home runs and led Tampa Bay with a .325 average (125-385) ... his .325 mark would have ranked third in the American League but he fell 84 plate appearances shy of qualifying for the batting title ... batted .376 (44-117) vs. left-handers, the highest mark in the AL, the fourth-best mark in baseball and second-best in Rays history behind Jason Bartlett (.379 in 2008) ... his .332 average (85-356) after the All-Star Break was fifth-best in the AL ... was the toughest player in the AL to strike out, fanning once every 13.5 plate appearances (31 SO/418 PA) ... accomplished the feat for the third consecutive season ... recorded more RBIs (40) than strikeouts in a season for the seventh time in his career ... appeared in 115 games and made 104 starts (41 at third base, 23 at second, 21 at first and 19 as the designated hitter) ... hit .333 (49-147) with two homers and 19 RBIs as the third baseman ... batted .343 (58-169) with five homers and 20 RBIs at Tropicana Field and .344 (65-189) in 61 games on turf ... tied for third in the AL in pinch hits (5-9, .556) ... hit cleanup as the designated hitter on 4/6 vs. the Yankees, his first Opening Day start in both spots ... the start was the second of his career on Opening Day (also 2008 with Cincinnati) ... hit .342 (116-339) from 4/22-remainder of the season, the best mark in the AL during that span (minimum 300 at-bats) ... was on the disabled list from 5/19-6/22 with a broken right great toe after being hit by a line drive while in the dugout on 5/19 vs. Atlanta ... appeared in six injury rehab games with Class AAA Durham ... matched his career high and the Tampa Bay club record with five hits on 6/23 at Philadelphia ... according to STATS LLC, became just the second player since 1982 to collect five hits in his first game after returning from the disabled list (also Troy Tulowitzki in 2009) ... hit his first career pinch-homer on 6/30 vs. Detroit ... batted .369 (31-84) in August, the second-best mark in the AL behind Prince Fielder (.370) ... surpassed his previous career high with his eighth homer on 9/25 at Boston. 2011 Acquired midseason by San Francisco from Houston after Giants 2B Freddy Sanchez suffered a season-ending shoulder injury...dealt for minor league RHP Henry Sosa and RHP Jason Stoffel on July 19...combined to hit .277 (105- for-379) with 20 2B, 6 HR and 35 RBI in 99 games between both clubs...made a combined 92 starts, all at 2B...Missed the first 50 games of the season while recovering from left foot surgery, performed to remove a sesamoid bone on Jan 14 in Charlotte, N.C., by Dr. Robert Anderson...For the third time in his career was the toughest to strike out in the NL, fanning only 24 times in 400 plate apps, and ranked 2nd in the majors behind CWS Juan Pierre...to put that into perspective, ML strikeout leader CIN Drew Stubbs fanned 24 times in an 11-game span in 2011...led the majors in 2008 (1 SO every 20.9 PA) and 2010 (1 SO every 15.97 PA)...Also ranks second to Pierre among active players with a career mark of just 1 SO per 16.11 PA...in his 3-year career at the University of Georgia he had just 44 SO in 714 AB...Had more RBI than strikeouts for the 6th time in 7 seasons...His final average of .277 was the lowest it had been all season...entered September with a .303 average, but batted only .177 (14-for-79) in the final month...Was 2-for-4 with the bases loaded and is 21- for-44 (.477) for his career, highest avg. among active players with the bases loaded (min. 50 PA) and the 4th-highest avg. since 1974...Although his .290 avg. vs. lefties was his lowest since 2006, his .325 avg. vs. southpaws over the past 5 years is 9th among major leaguers during that span...all 12 of his walks in 2011 were vs. righties...his last walk against a lefty was Sep 21, 2010 (WAS John Lannan)... From the time he returned from the DL on May 27 until he was traded to the Giants, he was the Astros 3rd-leading hitter behind Hunter Pence (.340) and Michael Bourn (.314)...Had 5 straight hits against the Rays, June 25- 26 at Minute Maid Park...his .458 (11-for-24) career average vs. the Rays is his highest against any opponent (min. 10 AB)...Started 54 of the Giants final 63 games... was the Giants leading hitter in August with a .313 (31-for-99) avg. ...missed 3 games when he injured his right wrist Aug 15 at ATL as he jammed it while colliding with 1B Freddie Freeman...batted .232 (29-for-125) over the remainder of the season. 2010 Hit .288 (148x514) with a club-best 34 doubles, six homers and 59 RBI in 137 games for Houston...set career highs in hits, doubles, runs scored (62), RBI, walks (51) and stolen bases (4)...his .288 average ranked second on the club in batting average, behind only Chris Johnson (.308), and was his highest since hitting a career-best .332 (80x241) in 67 games in 2007 for CIN... was the hardest batter to strikeout in the Majors in 2010 at once per 15.97 plate appearances...started a career-high 122 games at second base during the season...also made 10 starts at shortstop, his most since starting a career-high 101 games in 2008 for CIN... while he had 48 single-hit games, he posted a career-high 45 multi-hit games in 2010, including 10 games with at least three hits...were the most multi-hit games in a single season by an Astros second baseman since Craig Biggio had 56 multi-hit games in 2004... drove in a career-high four runs twice during the season, on May 19 vs. COL and Aug. 2 at STL...hit .304 (42x138) with 17 doubles and 10 RBI against left-handed pitchers, which ranked 25th among NL players vs. LHP...in September, hit .316 (30x95) with 13 RBI in 26 games...also hit above .300 in two other calendar months during the season: May (.314, 25g) and July (.353, 23g)...reached base safely in 14 consecutive games from Sept. 1-17, posting a .431 on-base percentage in that time frame....990 fielding pct. ranked 4th among NL second basemen...finished the season with a 48-game errorless streak...made just one error in his last 66 games after committing six errors in his first 68 games of the season...hit safely in 20 of his last 28 gms at .307 (31x101) with 13 RBI after Sept. 3...was on the 15-day Disabled List from Aug. 17-Sept. 1 with left big toe sesamoiditis... made two rehab outings at Double A Corpus Christi (2x5, RBI, BB)...prior to going on the DL, had 10 RBI in his previous 12 games from Aug. 2-16...posted a season-long, 10-game hit streak from May 30-June 8, during which he hit .385 (15x39) with two RBI. 2009 Hit .256 (78x305) with a career-high seven home runs and 29 RBI in 107 games with the Astros...acquired by Houston from Cincinnati during Spring Training...joined the club for the final four games of the preseason schedule...posted a .314 (32x102) batting average against left-handed pitching...started 33 of the club's 38 games against left-handed starters in 2009...made 76 starts, including 59 at third base, 14 at second base and three at shortstop...went 5x15 as a pinch-hitter...averaged just one strikeout every 10.42 plate appearances, which ranked seventh in the National League (min. 300 AB)...recorded his first career multi-homer game on Sept. 16 at CIN...missed seven team games from Sept. 5-11 with tightness in his back...also missed three games from June 13-16 with back soreness...homered off of Kyle McClellan in the top of the ninth inning on Aug. 27 at STL, which gave the Astros a 4-3 advantage...marked his second career go-ahead homer in the ninth inning or later, also on Sept. 9, 2006 at BOS...for the first time in his career, started three consecutive team games at three different positions from June 5-7... started at shortstop (June 5), third base (June 6) and second base (June 7)...became just the second player in the history of the Houston franchise to hit safely in his first eight games in an Astros uniform from April 7-22....Roman Mejias also did so for the Colt .45's from April 10-19, 1962...also became the first player to record three consecutive hits to start his Astros career since Chris James hit safely in his first four at-bats as an Astro from April 5-11, 1993...hit a bases-loaded, walk-off single on April 7 vs. CHC, which lifted the Astros to a 3-2 victory over the Cubs...by doing so, became the first Astro with a walk-off hit in his first atbat as an Astro since relief pitcher Jim Crawford also did so on April 10, 1973 vs. LAD. 2008 Struck out just once every 20.9 plate apps, best ratio in the National League...ranked fifth in the NL with a .360ba vs LHP...from 5/14-6/21 missed 36g while on the 15-day disabled list with a fractured left patella, an injury suffered when he fouled a ball off his kneecap on 5/13 vs Fla...played 2 more innings with the injury before he left the game...hit .324 in 39g before he went on the DL and .238 in 82g after he came off the DL...made 113 starts...led the club with 101 starts at SS...the last week of the season made all 3 of his starts at 2B...also started at 1B (2gs, 4/7 vs Phi & 4/13 at Pit) and 3B (7gs)...led the club with 79 starts batting second in the order...also hit first (7gs), third (1gs, 4/27 at SF), fifth (6gs), sixth (13gs) and seventh (7gs)...had 33 multi-hit games, including seven 3-hit games and a 5-hit game...played in the Reds' first 34g before a day off on 5/7 vs Chi...in the nightcap of the day/night DH at NYM on 5/10 produced a career-high 5 hits, the most by a Reds player in a game in 2008...from 5/10-5/11 produced 7 straight hits, the most since Adam Dunn had 7 consecutive hits from 7/26-7/27, 2006 at Hou...on those dates reached base safely in 8 straight plate apps (7h, 1bb), the most since Dunn reach safely in 9 straight from 7/26-7/27, 2006...on 7/8 at Chi singled off Ryan Dempster to snap a career-high 0-for-22 skid...had 1 of the club's 11 walkoff hits...in the 11th inning of the 4-3 win on 7/22 vs SD produced a game-ending, RBI-double off Bryan Corey...on 9/20 vs Mil made his first start of the season at 2B, in the club's 154th game. 2007 During 3 stints with the Reds hit .332 and reached base safely in 55 of his 67 apps...in August finished fourth in the National League in hitting (.393) and received NL Player of the Month Award votes... made 55 starts at 5 positions (43 at SS, 7 at 3B, 3 at 2B, 1 in LF, 1 in RF)...also made 1 appearance at 1B (8/30 at Pit)...from 8/12-8/28/g1 made 15 straight starts at SS while Alex Gonzalez was on the bereavement list (.377)...following Gonzalez' knee injury on 9/12 started at SS in 16 of the Reds' last 17g of the season and played 2B in the other (.323)...struck out only 12 times in 276 plate apps, best ratio in the majors (1k/23pa)... his career-high 14-game hitting streak from 8/11-8/25 (.421, 2hr, 7rbi, 19r) tied Javier Valentin for second on the club to Brandon Phillips' 22-game streak...in the batting order hit leadoff (2gs), second (42gs), third (1gs, 8/19 at Mil), fifth (2gs), sixth (6gs), seventh (1gs) and eighth (1gs)...began the season on the Reds' 15-day disabled list with a broken right ring finger suffered during spring training when he was hit by an Allan Simpson pitch (3/4 at Pit)...in his 4 spring apps before the injury went 6-for-8 (1hr, 2rbi)...on 4/19 was sent to FSL Sarasota on rehab...on 4/22 was recalled from his rehab, was reinstated from the DL and was optioned to Louisville...reached base safely in 52 of his 57 apps for the Bats and hit safely in 50-57...when promoted for the final time on 7/7 led the International League in hitting (.368) and ranked second in on-base percentage (.424)...spent the rest of the season with the Reds and hit .335 in his last 63 apps...on 7/22 at Fla produced a career-high 4 hits, including his first homer as a Red (off Rick Vanden Hurk)...was selected to play in the Triple-A All-Star Game and was Louisville's Player of the Month for June (.354). 2006 Split the season between the Mets and Royals organizations...in 119g at Class AAA combined to hit .316 at Norfolk and Omaha...on 7/19 was traded from NYM to KC...hit .354 in his 32 apps at Omaha, including a 13-game hitting streak from 7/24-8/5, before he was recalled on 8/25...finished the season with the Royals...for KC made 16 starts (12gs at 3B, 3gs at 1B, 1gs at 2B)...on 9/9 at Bos produced his first hit as a Royal, a game-winning 3-run HR off Manny Delcarmen in the 12th inning...hit .393 in his last 7g...ended the season with four 2-hit games (.444, 8-18, 1hr, 5rbi, 5r)...the 4-game hitting streak was his longest of the year...on 1/2 was designated for assignment by the Royals...8 days later was traded to the Reds. 2005 Missed most of the season with a fractured left tibia suffered on 6/15 in a collision with Charlotte's Felix Martinez...the next day went on Norfolk's disabled list and on 9/9 was transfered to the Mets' 60-day DL...at the time of the injury ranked first in the International League and sixth among all minor league batters with 86 hits...had 4 hits in the season opener vs Scranton-Wilkes/Barre...from 4/28-5/5 put together 7 straight multi-hit games (17-31, .548). 2004 In his Major League debut hit .284 in 33 apps, including 27 starts, for the Mets...in 102 minor league games combined to hit .337 for Class AA Altoona and Binghamton and Class AAA Norfolk...on 7/30, along with RHP Kris Benson was traded from the Pirates to the Mets...was promoted on 8/20 and in the fifth inning that night at SF made his Major League debut by grounding out as a pinch hitter...on 8/21 at SF singled off Jim Brower for his first career hit...on 8/28 vs LAD led off the game with his first career home run (off Odalis Perez)...on 8/28 and 8/29 vs LAD became the first Mets second baseman to homer in consecutive games since Roberto Alomar in 2002...posted 3-hit games on 9/11 vs Phi and 9/14 vs Atl...produced a pair of seasonbest 5-game hitting streaks (9/8-9/12, 9/22-9/28)...committed just 2 errors in 149 total chances (.987)..was an Eastern League All-Star and the Most Valuable Player of the Eastern League All-Star Game.


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We dedicated to bring Sportswear along with wide selection of Safety gloves and workwear. By teaming up with nevtechind.com you will always be one point ahead. Let the Nevtech Industries be your ultimate source of sportswear & gloves. It is our goal to manufacture high quality custom uniforms and sell them to the end user at affordable prices. For custom uniforms, please contact us today.


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Official Website of the City of Milwaukee
CALL for Action (414) 286-CITY | Click for Action
Milwaukee Health Department
The City of Milwaukee Health Department provides immunizations at its Walk-In Immunization Clinics.
Influenza (flu) vaccines are recommended for children 6-59 months.
*HPV is a 3 dose vaccine series for females only
Other shots might be recommended to you by your health care provider.
Persons who belong to a health maintenance organization (HMO) or who have other insurance programs that cover immunizations should see their physician for necessary immunizations.
Remember, even teens and adults may benefit from Hep B, MMR and Td vaccinations.
Design by City of Milwaukee


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So you want to watch AMA Pro Road Racing and AMA Pro Flat Track this year, but because DMG screwed the pooch on securing any form of TV deal, you think you're up an apex without a kneepuck, right? Not so fast there speed racer.
To its credit, the Daytona Motorsports Group has created its own live streaming site for AMA Pro Racing, IMSA, and NASCAR content that is not on television: FansChoice.tv, which will be your go-to destination for watching the Daytona 200 live this weekend.


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This Week In Island History
The news of 10 and 15 years ago is from the Jamestown Press. The news of 100 years ago came from the collection of the Newport Historical Society.
100 years ago
From the Newport Journal, Sept. 6, 1912
The weekly shoot of the Diamond Spring Rifle Club was held Friday evening at the range on Southwest Avenue. Alderson won the shoot and the bronze handicap bar, and also shot high string.
The Saturday evening dances and the music nightly will be continued at the Casino until the last week in September.
The annual clambake for the Carr descendants was held at the homestead on Carr's Lane Sunday. There was a good number present, the younger generation predominating.
75 years ago
From the Newport Daily News, Sept. 1, 1937
One of the largest crowds ever attending a function at the Beavertail Country Club was seen Monday evening when the Jamestown annual fireman's ball was held, more than 300 being present.
From the Newport Daily News, Sept. 3, 1937
The report of the chairman of swimming for the Jamestown chapter of the American Red Cross showed 26 children received beginner's pins, 33 swimmer's pins and seven received first life-savings awards. The chapter, through the cooperation of the YWCA Seaside Camp, provided the instructor.
From the Newport Daily News, Sept. 7, 1937
The fine weather on Labor Day brought many visitors to the island, and many end-ofthe season house parties, beach parties, and suppers on the rocks at Beavertail and along the shore were held.
50 years ago From the Newport Daily News,
Sept. 5, 1962
After nine months of delays, the superstructure of the new Brenton Reef Light is in place on top of the steel tower legs. From the Newport Daily News,
Sept. 7, 1962
Jamestown's Town Council and planning board were unable, at a joint meeting last night, to resolve their differences on the type of a zoning code that should be adopted.
25 years ago From the Newport Daily News,
Sept. 4, 1987
Two-hundred-fifty acres of land on the north end and south side of Dutch Island Harbor have been donated to the state by two local residents for preservation of wildlife, agriculture, and scenery. (The donated land included 150 acres on the south side of Dutch Harbor and 90 acres at Fox Hill, between Fort Getty recreation Area and Sheffield Cove. Another 10 acres was donated of salt marsh land at Great Creek.)
15 years ago
From the Jamestown Press,
Sept. 4, 1997
Local merchants practically gushed with enthusiasm when asked how their businesses fared this summer. In a random survey, many attributed their successes, in part, to the beautiful weather.
The Zoning Board of Review last Tuesday denied an application by AT&T Wireless services for a special-use permit to install a 75- foot flagpole with attached radio frequency antennas on the site of the state-owned pumping station at North Main Road and Route 138.
School Committee Chairwoman Sirje Carl said the committee decided last Thursday that a fee of $20 per hour for programs or sporting events in the Jamestown school gymnasiums will now be charged groups who are not affiliated with either the school department or recreation department.
10 years ago
From the Jamestown Press,
Sept. 5, 2002
"Keep it down," someone in the audience suggested as a town councilor unquietly rearranged a few chairs when the noise workshop at the library was beginning last Thursday night, Aug. 29. The discussion highlighted several aspects of the island's noise and possible noise control.
In a special meeting last Wednesday, Aug. 28, the Harbor Management Commission heard three hours of, at times, emotional discussion on a proposed revision of Section 6 of the Harbor Management Ordinance. Questions and comments from the public during the review of mooring regulations reflected concerns over the stagnant waiting list for moorings and fears of losing guest moorings.
Nearly 100 sailing vessels circumnavigated Conanicut Island Sunday in what has continued to be the longest running sailing race sponsored by the Conanicut Yacht Club to be held anywhere in Narragansett Bay.


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YouTube User Discloses HIV-Positive Status in Video
February 17, 2014
Making the decision to disclose your HIV status is a big deal -- so why not do it in a big way? For Nolan Hill, the Internet was the best venue to tell his story. "I would really like to educate others about HIV stigma, and all that people go through when diagnosed," he said. In a 17-minute video titled "My Confession" that he posted to YouTube on Jan. 20, Hill masterfully tells his story by weaving together pre-written cue cards and a Top-40 playlist including songs by Katy Perry, Sara Bareilles and Pink.
Hill's story is remarkable. It includes his challenges coming out as gay, his issues with his family and a car accident that started the events leading to his diagnosis. Check out the video below:
Mathew Rodriguez is the editorial project manager for TheBody.com and TheBodyPRO.com.
Follow Mathew on Twitter: @mathewrodriguez.
Copyright © 2014 Remedy Health Media, LLC. All rights reserved.
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Recall Details
The tire pressure and loading information label may be incorrect. This could lead to improper vehicle loading or tire pressures that could result in a tire failure. Dealers will mail the correct label to vehicle owners. This recall is expected to begin on December 18, 2006. The Volvo recall number is 161.
Our Quick Take
The tire pressure and loading label may be incorrect. Improper vehicle loading or tire pressure could lead to tire failure, increasing the risk of a crash.
What Should You Do?
Please contact your Nissan or Infiniti dealer. They will check to see if your specific vehicle is affected and advise you on what to do next. Always have your vehicle identification number (VIN) handy when you call.


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An important determinant of "where medicine will be" in 2035 is the set of dynamics and forces behind healthcare delivery systems, including primarily the payment method, especially regarding reimbursement. It is clear that some form of reform in healthcare will result in a consolidation of the infrastructure paying for and managing patient populations. The infrastructure is bloated and expensive, unnecessarily adding to costs that neither the federal government nor individuals can sustain. This is not to say that I predict movement to a single payer system — that is just one perceived solution to the problem. There are far too many costs in healthcare that offer no benefits in terms of quality; indeed, such costs are a true impediment to quality. Funds that go to infrastructure (insurance companies and other intermediaries) and the demands they put on healthcare delivery work directly against quality of care. So, in the U.S., whether Obamacare persists (most likely) or is replaced with a single payer system, state administered healthcare (exchanges) or some other as-yet-unidentified form, there will be change in how healthcare is delivered from a cost/management perspective.
From the clinical practice and technology side, there will be enormous changes to healthcare. Here are examples of what I see from tracking trends in clinical practice and medical technology development:
- Cancer 5 year survival rates will, for many cancers, be well over 90%. Cancer will largely be transformed in most cases to chronic disease that can be effectively managed by surgery, immunology, chemotherapy and other interventions. Cancer and genomics, in particular, has been a lucrative study (see The Cancer Genome Atlas). Immunotherapy developments are also expected to be part of many oncology solutions. Cancer has been a tenacious foe, and remains one we will be fighting for a long time, but the fight will have changed from virtually incapacitating the patient to following protocols that keep cancer in check, if not cure/prevent it.
- Diabetes Type 1 (juvenile onset) will be managed in most patients by an "artificial pancreas", a closed loop glucometer and insulin pump that will self-regulate blood glucose levels. OR, stem cell or other cell therapies may well achieve success in restoring normal insulin production and glucose metabolism in Type 1 patients. The odds are better that a practical, affordable artificial pancreas will developed than stem or other cell therapy, but both technologies are moving aggressively and will gain dramatic successes within 20 years.
Developments in the field of the "artificial pancreas" have recently gathered considerable pace, such that, by 2035, type 1 blood glucose management may be no more onerous than a house thermostat due to the sophistication and ease-of-use made possible with the closed loop, biofeedback capabilities of the integrated glucometer, insulin pump and the algorithms that drive it, but that will not be the end of the development of better options for type 1 diabetics. Cell therapy for type 1 diabetes, which may be readily achieved by one or more of a wide variety of cellular approaches and product forms (including cell/device hybrids) may well have progressed by 2035 to become another viable alternative for type 1 diabetics.
- Diabetes Type 2 (adult onset) will be a significant problem governed by different dynamics than Type 1. A large body of evidence will exist that shows dramatically reduced incidence of Type 2 associated with obesity management (gastric bypass, satiety drugs, etc.) that will mitigate the growing prevalence of Type 2, but research into pharmacologic or other therapies may at best achieve only modest advances. The problem will reside in the complexity of different Type 2 manifestation, the late onset of the condition in patients who are resistant to the necessary changes in lifestyle and the global epidemic that will challenge dissemination of new technologies and clinical practices to third world populations.
Despite increasing levels of attention being raised to the burden of type 2 worldwide, including all its sequellae (vascular, retinal, kidney and other diseases), the pace of growth globally in type 2 is still such that it will represent a problem and target for pharma, biotech, medical device, and other disciplines.
- Cell therapy and tissue engineering will offer an enormous number of solutions for conditions currently treated inadequately, if at all. Below is an illustration of the range of applications currently available or in development, a list that will expand (along with successes in each) over the next 20 years.
Cell therapy will have deeply penetrated virtually every medical specialty by 2035. Most advanced will be those that target less complex tissues: bone, muscle, skin, and select internal organ tissues (e.g., bioengineered bladder, others). However, development will have also followed the money. Currently, development and use of conventional technologies in areas like cardiology, vascular, and neurology entails high expenditure that creates enormous investment incentive that will drive steady development of cell therapy and tissue engineering over the next 20 years, with the goal of better, long-term and/or less costly solutions.
- Gene therapy will be an option for a majority of genetically-based diseases (especially inherited diseases) and will offer clinical options for non-inherited conditions. Advances in the analysis of inheritance and expression of genes will also enable advanced interventions to either ameliorate or actually preempt the onset of genetic disease.
As the human genome is the engineering plans for the human body, it is a potential mother lode for the future of medicine, but it remains a complex set of plans to elucidate and exploit for the development of therapies. While genetically-based diseases may readily be addressed by gene therapies in 2035, the host of other diseases that do not have obvious genetic components will resist giving up easy gene therapy solutions. Then again, within 20 years a number of reasonable advances in understanding and intervention could open the gate to widespread "gene therapy" (in some sense) for a breadth of diseases and conditions –> Case in point, the recent emergence of the gene-editing technology, CRISPR, has set the stage for practical applications to correct genetically-based conditions.
- Drug development will be dramatically more sophisticated, reducing the development time and cost while resulting in drugs that are far more clinically effective (and less prone to side effects). This arises from drug candidates being evaluated via distributed processing systems (or quantum computer systems) that can predict efficacy and side effect without need of expensive and exhaustive animal or human testing.The development of effective drugs will have been accelerated by both modeling systems and increases in our understanding of disease and trauma, including pharmacogenomics to predict drug response. It may not as readily follow that the costs will be reduced, something that may only happen as a result of policy decisions.
- Most surgical procedures will achieve the ability to be virtually non-invasive. Natural orifice transluminal endoscopic surgery (NOTES) will enable highly sophisticated surgery without ever making an abdominal or other (external) incision. Technologies like "gamma knife" and similar will have the ability to destroy tumors or ablate pathological tissue via completely external, energy-based systems.
By 2035, technologies such as these will measurably reduce inpatient stays, on a per capita basis, since a significant reason for overnight stays is the trauma requiring recovery, and eliminating trauma is a major goal and advantage of minimally invasive technologies (e.g., especially the NOTES technology platform). A wide range of other technologies (e.g., gamma knife, minimally invasive surgery/intervention, etc.) across multiple categories (device, biotech, pharma) will also have emerged and succeeded in the market by producing therapeutic benefit while minimizing or eliminating collateral damage.
Information technology will radically improve patient management. Very sophisticated electronic patient records will dramatically improve patient care via reduction of contraindications, predictive systems to proactively manage disease and disease risk, and greatly improve the decision-making of physicians tasked with diagnosing and treating patients.There are few technical hurdles to the advancement of information technology in medicine, but even in 2035, infotech is very likely to still be facing real hurdles in its use as a result of the reluctance in healthcare to give up legacy systems and the inertia against change, despite the benefits.
- Personalized medicine. Perfect matches between a condition and its treatment are the goal of personalized medicine, since patient-to-patient variation can reduce the efficacy of off-the-shelf treatment. The thinking behind gender-specific joint replacement has led to custom-printed 3D implants. The use of personalized medicine will also be manifested by testing to reveal potential emerging diseases or conditions, whose symptoms may be ameliorated or prevented by intervention before onset.
- Systems biology will underlie the biology of most future medical advances in the next 20 years. Systems biology is a discipline focused on an integrated understanding of cell biology, physiology, genetics, chemistry, and a wide range of other individual medical and scientific disciplines. It represents an implicit recognition of an organism as an embodiment of multiple, interdependent organ systems and its processes, such that both pathology and wellness are understood from the perspective of the sum total of both the problem and the impact of possible solutions.This orientation will be intrinsic to the development of medical technologies, and will increasingly be represented by clinical trials that throw a much wider and longer-term net around relevant data, staff expertise encompassing more medical/scientific disciplines, and unforeseen solutions that present themselves as a result of this approach.Other technologies being developed aggressively now will have an impact over the next twenty years, including medical/surgical robots (or even biobots), neurotechnologies to diagnose, monitor, and treat a wide range of conditions (e.g., spinal cord injury, Alzheimer's, Parkinson's etc.).
The breadth and depth of advances in medicine over the next 20 years will be extraordinary, since many doors have been recently opened as a result of advances in genetics, cell biology, materials science, systems biology and others — with the collective advances further stimulating both learning and new product development.
See the 2016 report #290, "Worldwide Markets for Medical and Surgical Sealants, Glues, and Hemostats, 2015-2022."


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One of my favorite authors, Terry Pratchett, said that to be a good writer you must read extensively outside and inside your genre. I think this is very good advice.
Now, our genre is webcomics, and I know we all probably read eachothers and our own non comic genesis favorites, but what about outside our genres? Here's some some random things that were useful to me.
Pretty much anything on eZine. Ezine is place where people publish their articles for free and then advertised whatever product/service they have. I have found that the sections on both selling and romance provide and endless supply of ideas. It is not hard for me to say, "one of my characters might do that."
Various Podcasts. My comic centers on religion, so I listen to a lot of preachers/teachers. I try to challenge myself to listen to guys that I don't agree with or like (I have a degree in Theology), because it provides great foil for either the beliefs of my characters or just plain old satire fodder. Mark Driscoll is getting spoofed in my comic in January.
Blogs. Blogs. Blogs. I think I have gotten at least three or four good ideas from reading random blogs on the internet. I am becoming far less discriminating it what I put on my list to read.
What random, non-comic related, literture has given any of you guys good ideas?


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Hepatitis B and HIV/AIDS
October 24, 2015
Table of Contents
What Is Hepatitis B?
Hepatitis is an inflammation, or swelling, of the liver. Alcohol, drugs (including prescription medications), poisons, and some viruses can all cause hepatitis. Hepatitis B is a liver disease caused by the hepatitis B virus (HBV).
Worldwide, approximately 240 million people are chronically infected with HBV, and one in ten of these are also infected with HIV. In the US, an estimated one million people are infected with HBV. Among people living with HIV (HIV+) in the US, about one in ten are co-infected with HBV.
Most people, about nine out of every ten healthy adults, fight off the hepatitis B infection themselves and usually recover within a few months. While they will never get HBV again, their blood test will always show that they have been infected.
The remaining ten percent of people -- those who do not fight off the infection themselves -- develop chronic hepatitis B. Chronic hepatitis B is a long-term illness that happens when HBV stays in the body longer than six months. Fifteen to 25 percent of people with chronic HBV develop serious complications including liver damage (cirrhosis or scarring) or liver cancer, usually after many years. In the most serious cases, a person may need a liver transplant. People with chronic HBV infection also become carriers of the infection and can pass the virus on to others.
Although people with both HIV and HBV have less inflammation in the liver, they have higher rates of HBV-associated liver disease. Several studies have also shown that HBV infection could increase the risk of liver damage for people taking HIV medications.
How Is HBV Spread?
HBV is more contagious than HIV. It is spread through infected bodily fluids, including blood, semen, vaginal secretions, and breast milk. HBV can be spread through:
Pregnant women who have HBV can pass HBV on to their babies fairly easily (up to nine times out of ten). Similarly, up to nine out of every ten infants who become infected with HBV will develop chronic HBV (unlike adults, in whom nine out of ten people infected clear the virus naturally). The good news is that infants can be given immune treatments at birth to greatly reduce the chances that they will become chronically infected or suffer any liver damage.
Prevention of HBV
Fortunately, if you have never had HBV, it can be prevented. Getting vaccinated for HBV is the best protection against the virus. In order to be fully protected, three shots are required over the course of six months. There is also a combined vaccine that will protect you from both HBV and hepatitis A (HAV). It is important to follow through and get all your shots in order to be fully protected.
HBV vaccination is recommended for all infants (first dose at birth), all children younger than 19 years who have not been vaccinated, and all sexually active persons who are not in a long-term monogamous relationship with someone who does not have hepatitis B. It is also recommended for people living with HIV (HIV+), men who have sex with men, people with multiple sex partners or a diagnosis of a sexually transmitted disease, injecting and non-injecting drug users, people who have close household contact with an HBV-infected person, and health care workers.
The HBV vaccine is recommended for people living with HIV. However, HIV infection can reduce the response to the HBV vaccine. People living with HIV who are vaccinated should be tested for HBV antibodies one to two months after the third vaccine dose to make sure their bodies are fully protected against HBV. Revaccination or higher doses of vaccine may be necessary for people who do not respond to the first three regular doses.
People who do not respond to additional doses may remain susceptible to HBV infection and should consider taking additional action to prevent infection with HBV. Examples of such preventive action include: using latex barriers during sex (see The Well Project's article on Safer Sex), not sharing needles or drug equipment, and making sure that tattoo artists use sterile needles and sterile inkwells. If you inject drugs and do not have access to sterile needles and other drug equipment, see our article on Cleaning Works.
Babies born to women carrying HBV are at high risk of getting HBV immediately after delivery. The risk is increased in women who are co-infected with HIV. It is now recommended that all pregnant women be tested during the first three months of pregnancy for HBV. The HBV vaccine is safe during pregnancy and is recommended for the infant if the mother tests positive during pregnancy. Babies born to HBV-positive mothers get the first shot of HBV vaccine at birth as well as one shot of HBIG (Hepatitis B Immune Globulin), which helps them fight off HBV infection.
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This article was provided by The Well Project. Visit The Well Project's Web site to learn more about their resources and initiatives for women living with HIV. The Well Project shares its content with TheBody.com to ensure all people have access to the highest quality treatment information available. The Well Project receives no advertising revenue from TheBody.com or the advertisers on this site. No advertiser on this site has any editorial input into The Well Project's content.
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Saimiri vanzolinii
|Scope: Global
Language: English
|Scientific Name:
|Saimiri vanzolinii Ayres, 1985
Common Name(s):
|Taxonomic Notes:
|Saimiri taxonomy follows Hershkovitz (1984) and Groves (2001, 2005). An alternative taxonomy is presented by Thorington Jr. (1985) as follows: S. sciureus sciureus (includes the forms albigena, macrodon, and ustus recognized by Hershkovitz, [1984]), S. sciureus boliviensis (includes the forms pluvialis Lönnberg, 1940 and jaburuensis Lönnberg, 1940 recognized by Hershkovitz [1987]), S. sciureus cassiquiarensis, S. sciureus oerstedii (includes the form citrinellus recognized by Hershkovitz [1984]), and S. madeirae (given as a junior synonym of S. ustus by Hershkovitz [1984]). Hernández-Camacho and Defler (1989) recognize S. sciureus caquetensis Allen 1916, given as a junior synonym of S. sciureus macrodon by Hershkovitz (1984). Costello et al. (1993) argued for the recognition of just two species: S. sciureus in South America, and S. oerstedii in Panama and Costa Rica. Boinski and Cropp (1999) using two nuclear genes (IRBP and ZFX) and one mitochondrial (D-Loop) strongly support the Hershkovitz (1984) taxonomy, advocating four distinct species: Saimiri sciureus, S. boliviensis, S. oerstedii and S. ustus.
Hershkovitz (1987) referred to S. vanzolinii as a subspecies of S. boliviensis.
|Red List Category & Criteria:
|Vulnerable D2 ver 3.1
|Year Published:
|Date Assessed:
|Boubli, J.-P. & Rylands, A.B.
|Mittermeier, R.A. & Rylands, A.B. (Primate Red List Authority)
This species is listed as Vulnerable given that its entire range is confined to the Mamirauá State Sustainable Development Reserve, which although well managed and free of hunting, nonetheless is susceptible to selective logging, especially along the main stream of the Amazon.
|Previously published Red List assessments:
|Range Description:
|This species has a very small range circumscribed by the Rios Solimões and Japurá and the Auatí-Paraná (Ayres 1985).
|Countries occurrence:
Native:Brazil (Amazonas)
|Additional data:
|Range Map:
|Click here to open the map viewer and explore range.
|Common in a large part of its range. It has been recorded at a population density of 2.8 groups/km² (Ayres 1986).
|Current Population Trend:
|Additional data:
|Habitat and Ecology:
|Typically prefers seasonally inundated forests, river edge forest, floodplain, and secondary forests. They use all levels of the forest, but forage and travel mainly in the lower canopy and understorey. Locomotion involves predominantly quadupredal walking and running.
Squirrel monkeys are small frugivore-insectivores. They spend 75-80% of their day foraging for insects and other small animal prey (Mittermeier and Van Roosmalen 1981; Terborgh 1983; Boinski 1988). During dry season shortages of appropriate fruiting trees they are able to depend entirely on animal prey (Janson and Boinski 1992).
Saimiri groups are multi-male and can be large, up to 100 animals (larger groups are believed to be temporary mergers of two) but most frequently are of 20-75 individuals (Baldwin and Baldwin 1981; Terborgh 1983; Mitchell et al. 1991). As emphasized by Boinski (1999a,b; 2005; Boinski et al. 2005a,b), allthough all squirrel monkeys are morphologicallly very similar, their social systems are quite distinct (summarized in Sussman 2000). However, there have been no studies of this species to date, and its ecology is inferred from those of other species. It is probable that its social orgnaization will be similar to that of S. boliviensis.
Mating and births in Saimiri are highly seasonal, seldom exceeding two months in duration. Single offspring. Mating usually occurs during the dry season. In S. oerstedii, sexual receptivity in females is synchronized, and lasts only or two days each season. In S. sciureus, birth synchrony is less pronounced and births occur only once every two years.
Amazonian Saimiri frequently form interspecific associations, travelling with Cebus albifrons or Cebus apella (Terborgh 1983; Wallace et al. 2000), benefitting from the disturbance casued by the capuchin monkeys above them which flushes out insects.
Size: Adult male 950 g; adult female 650 g (Jack 2007).
|Major Threat(s):
|The entire range of S. vanzolinii is within the Mamirauá State Sustainable Development Reserve (1,124,000 ha) (Rylands 1994). People are living within the reserve, but are permitted to use natural resources sustainably. The species is not known to be hunted. This species was formerly thought to be declining due to hybridization with S. s. cassiquiarensis, but this is uncertain.
|Conservation Actions:
|As noted, the species occurs entirely in the Mamirauá State Sustainable Development Reserve (1,124,000 ha) (Ayres 1984; Queiroz 1995). It is listed on CITES Appendix II.
|Boubli, J.-P. & Rylands, A.B. 2008. Saimiri vanzolinii. The IUCN Red List of Threatened Species 2008: e.T19839A9023022. . Downloaded on 25 September 2018.
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