Gonococcal endocarditis, like other gonococcal infections, occurs mainly in the young adult population. The onset of the disease tends to be subacute with an infrequent history of preceding infection or the discovery of a local source of infection. The presenting symptoms and signs fail to differentiate it from other types of endocarditis. Blood cultures are often negative for the first several days. Echocardiography has been useful in helping establish a diagnosis, and survival is favorable with medical and surgical therapy if the diagnosis is made early in the course of the disease. The disease can be quite aggressive, however, and lead to rapid clinical deterioration from valvular destruction and congestive heart failure. As with other forms of endocarditis, deterioration is an indication for aggressive management with early valve replacement.