This patient has gonorrhea, and since 1986, increasing penicillin resistance has meant that penicillin/ampicillin are no longer drugs of choice. Alternatives to ceftriaxone include ciprofloxacin, ofloxacin, or cefixime given orally, with 7 days of doxycycline, or a single 1 g dose of azithromycin in case of coinfection with Chlamydia. In Asia and the Pacific (as well as in California), quinolones are not considered first-line therapy because of the high rate of resistant organisms. In these locations, ceftriaxone is the drug of choice. In pregnant women, erythromycin replaces doxycycline. Disseminated gonococcal infection should be treated in a hospital with IV antibiotics.