GONORRHEA INFECTIONS IN CHILDREN OCCURRING IN ANY BODY SITE EXCEPT THE EYES ARE VIRTUALLY ALWAYS AN INDICATOR THAT THE INFECTED CHILD HAS BEEN A VICTIM OF SEXUAL ASSAULT. AFTER THE NEONATAL PERIOD, GONORRHEA INFECTION IN CHILDREN AND ADULTS IS NEARLY ALWAYS A LOCAL RATHER THAN A SYSTEMIC INFECTION. INFECTIONS ARE PASSED FROM ONE PERSON TO ANOTHER BY DIRECT CONTACT WITH THE MOIST MUCOUS MEMBRANES OF AN INFECTED PERSON. CHILDREN ACQUIRE THE INFECTION WHEN THEY HAVE HAD ORAL-GENITAL, GENITAL-GENITAL, OR RECTAL-GENITAL CONTACT WITH SOMEONE ELSE (USUALLY AN ADULT) WHO ALREADY HAD A GONORRHEA INFECTION IT IS IMPORTANT IN THE EXAMINATION OF INFECTED CHILDREN SUSPECTED OF HAVING BEEN SEXUALLY ASSAULTED THAT MOST CHILD VICTIMS OF SEXUAL ASSAULT HAVE NO EXTERNAL EVIDENCE OF TRAUMA. THE SEXUAL CONTACT IS FREQUENTLY NONVIOLENT AND LIMITED TO NONTRAUMATIC MANIFESTATIONS SUCH AS FONDLING, FELLATIO, AND GENITAL-GENITAL SURFACE CONTACT, WITHOUT FORCIBLE PENETRATION. THREFORE, A PHYSICIAN EXAMINING AN INFECTED CHILD SHOULD NOT ASSUME THE ABSENCE OF SEXUAL ASSAULT SIMPLY BECAUSE THERE IS NO EVIDENCE OF PHYSICAL TRAUMA. PHYSICIANS ARE OFTEN RELUCTANT TO PERFORM GENITAL EXAMINATIONS ON FEMALE CHILDREN, AND AS A RESULT, SUSPECTED ASSAULT VICTIMS BROUGHT TO HOSPITALS ARE NOT ADEQUATELY EXAMINED, AND CASES OF GONORRHEA GO UNDIAGNOSED. THE AUTHOR RECOMMENDS THAT A CHILD SEXUAL ASSAULT EXAMINATION INCLUDE THE FOLLOWING COMPONENTS, REGARDLESS OF THE AGE OF A CHILD: OVERALL EXAMINATION, GENITAL EXAMINATION, VENEREAL DISEASE SCREENING, VENEREAL DISEASE PROPHYLAXIS AND FOLLOWUP, INTERVIEWING, AND EXAMINATION OF OTHER CHILDREN-AT-RISK. MEDICAL LITERATURE REGARDING TRANSMISSION OF PEDIATRIC GONORRHEA IS REVIEWED AND DISCUSSED. CROSS-REPORTING OF PEDIATRIC GONORRHEA AND JOINT INVESTIGATION OF CASES BY PUBLIC HEALTH AND CHILD PROTECTIVE SERVICES AUTHORITES ARE SEEN AS ESSENTIAL IF ADEQUATE CHILD PROTECTION ALONG WITH COMMUNICABLE DISEASE CONTROL, IS TO BE ACHIEVED. TECHNIQUES SUGGESTED FOR DEALING WITH AN INFECTED CHILD'S FAMILY INCLUDE AVOIDING A JUDGMENTAL ATTITUDE, INTERVIEWING THE CHILD AND HIS/HER SIBLINGS ALONE, AND AVOIDING CONFRONTATION OF A CHILD'S PARENTS WITH AN UNSUPPORTED ACCUSATION BY THE CHILD UNLESS THE CHILD CAN BE PROTECTED FROM RETRIBUTION. SPECIFIC CASE HISTORIES ARE SUMMARIZED THROUGHOUT THE ARTICLE, AND REFERENCES ARE PROVIDED. (VDA)