Sexual abuse of a minor is the involvement of a child in sexual activity. This is because he/she is developmentally unprepared, does not understand, and cannot give informed consent. The society underestimates this significant problem as many cases go unreported. This study reports the index case of sexual abuse of a 6-year-old orphan by an adult. She was brought to the Children’s Emergency Room of David Umahi Federal University Teaching Hospital (DUFUTH), Uburu, Ebonyi State, Nigeria by a neighbor on account of sexual abuse by penetration on three different occasions by the same person. It was the third episode that the child volunteered the information after the assailant was caught in a similar act. She was managed by the Gender-Based Violence (GBV) unit of DUFUTH where necessary examinations, counseling, laboratory investigation, and follow-up were done, including Anti-retroviral screening. She was placed on antibiotics for one week, post-exposure prophylaxis for 28 days, and recommended for a second anti-retroviral screening in three months. She was also referred to the Gender-Based Violence (GBV) Unit of a State General Hospital for collaboration and further documentation in the approved GBV register