• The charts of children younger than 13 years with culture-proved genital herpes simplex virus (HSV) were reviewed to determine how acquisition of the infection was documented and whether sexual abuse had been investigated. Six children (four girls and two boys) had genital HSV infection: five had type 1 HSV and one had type 2 HSV. None had serologic evidence of syphilis or culture-proved gonorrhea. Sexual abuse was documented in four of six patients. We concluded that genital HSV in children is frequently sexually transmitted and should always be considered a possible indicator of child abuse. Confirmation of HSV infection by culture is important to substantiate suspicious circumstances, since it may occur in the absence of either a history of sexual abuse or of other sexually transmitted diseases.