Sexually transmitted infections (STI) comprise a variety of infections transmissible through sexual contact. Mutually consenting sexual relationships have become commonplace in adolescence and sexual abuse or exploitation awareness has risen, resulting in increased presentations of children with sexual health concerns. Difficulties persist in diagnosing and managing STIs in children. With increased emphasis on paediatrician's involvement in transitional care, competence in sexual history taking and clinical presentation recognition remains essential. Additionally, an awareness of strengths and limitations of diagnostic modalities needs to be present. Furthermore, specific additional issues in this age group such as independent consent for diagnosis and treatment, fear of pregnancy and privacy and confidentiality concerns should be addressed carefully. Failure to address these issues may lead to disengagement with health services resulting in potentially adverse short- and long-term health and social consequences in young persons. This review aims to provide an overview of an approach to diagnosing and managing a pubertal child with an STI and the consideration of the unique issues surrounding children's care.