To determine the prevalence and pattern of sexually transmitted diseases among sexually abused children, we evaluated 532 victims under 14 years of age for the presence of Neisseria gonorrhoeae and Treponema pallidum. Twenty-five girls with vaginal discharge and six children with perineal skin lesions underwent more detailed microbiologic examination. Thirty-four infections were identified in 33 children. Gonorrhea was present in 25 (4.7%) of the 532 children, and other sexually transmitted diseases were identified in nine children. Rates of gonococcal infection were higher for children with multiple episodes of abuse (8.1%), delayed reporting (7.4%), and for children evaluated for "suspicion of abuse" without a specific history (28%). Eight gonococcal infections (32%) were discovered at sites not involved in the abuse, according to the child's history. Eleven (44%) infected children were asymptomatic. Routine cultures of oropharyngeal and anogenital sites detected clinically unsuspected cases of oral, vaginal, and rectal gonorrhea. These data suggest that routine cultures are indicated for sexually abused children.