Septic arthritis remains an uncommon but not rare occurrence, with the potential for catastrophic morbidity if not recognized and treated early with appropriate antimicrobial agents. The role of Neisseria gonorrheae is well established in the differential diagnosis of septic arthritis in the young, sexually active population and particularly in monoarticular presentations. Gonococcal septic arthritis occurring without genital symptoms is not emphasized, although it has been described previously. The length of time from exposure to N. gonorrheae to the development of pyogenic arthritis is variable but usually is within 3 weeks. We report 4 cases of septic arthritis due to N. gonorrheae occurring in our hospital within 18 months (approximately 5.3% of septic arthritis), with prolonged intervals from initial exposure and with minimal to no genital symptoms.