A 32-year-old nonlactational women with a nipple piercing and previous oral-to-breast contact presented with findings consistent with mastitis and abscess, however, the patient failed multiple courses of empiric antimicrobials. Needle aspiration was performed and the culture was positive for N. gonorrhoeae. She was successfully treated with intravenous ceftriaxone and transitioned to oral ciprofloxacin once susceptibilities were known. N. gonorrhoeae is an uncommon cause of nonlactational mastitis and abscess. A few cases have been reported in the context of sexual contact and nipple piercings. In an era of increasing antimicrobial resistance and with the risk of disseminated gonococcal infection, a high index of suspicion should be maintained within this clinical context.