Osteomyelitis is a rare complication of disseminated gonoccal infection. We report a case of gonococcal osteomyelitis and review the other eight proved or probable cases that have been described in the English-language literature since the introduction of antibiotics. Two cases were caused by beta-lactamase-producing strains. The single common characteristic of patients with gonococcal osteomyelitis was a substantial delay (mean 37 days) between the onset of joint symptoms and the institution of appropriate antibiotic therapy. The duration of antibiotic therapy varied from 12 days to six weeks and did not correlate with outcome. Only three patients enjoyed complete resolution of both symptoms and roentgenographic abnormalities.