Disseminated infection is a serious complication in approximately 2 percent of primary gonococcal infections. Meningeal infection is very rare; only 23 cases have been reported since 1922. We report a sexually active teenager with an acute febrile illness. From her cerebrospinal fluid cultures, Neisseria gonorrhoeae was identified. She recovered completely after treatment with ceftriaxone and penicillin. Possible explanations for gonococcal dissemination include unique strains of the organism as well as particular complement deficiencies of the host. Aggressive efforts by physicians to prevent, identify, and treat primary gonococcal diseases should continue because this will reduce the frequency of serious complications.