Sexually transmitted diseases pose a significant problem for children who have been sexually abused. The pattern of sexually transmitted diseases in this group reflects their changing pattern in the community at large. The prevalence of sexually transmitted diseases in sexual abuse victims is significant although it depends on a number of factors, including sexually transmitted disease prevalence in the community, the organism, and the type of abuse. The transmission route of most common sexually transmitted diseases beyond the neonatal period is accepted as sexual abuse, although the possibility of nonsexual transmission of some organisms, particularly those that can be transmitted at birth and have a long incubation and latency periods, is recognized. Mounting evidence for nonsexual transmission of human papillomavirus is generating continuing controversy. The significance of other organisms as indicators of abuse remains unclear. It is recommended that children suspected of being abused be screened for sexually transmitted diseases. There has been considerable discussion about the extent of screening. Screening should adhere to clear guidelines that address local epidemiologic issues. Screening for human immunodeficiency virus should be based on the extent of the virus in the community in which the child lives and on the nature of the abuse. Child sexual abuse must be recognized as an exposure category for human immunodeficiency virus. Test selection for evaluating sexually transmitted diseases in sexual abuse victims is a critical issue. Rapid screening methodologies should not be relied on, and if positive results are obtained, they should be confirmed using another method or even another laboratory. Prophylaxis is generally not seen as necessary and the more recent treatment guidelines recommended by the Centers for Disease Control are generally accepted as more appropriate for children. Future refinements in treatment may include moves to both oral and monotherapy.