Background and Objective: Surveillance for sexually transmitted diseases (STD) is important for priority setting, service development, and evaluating interventions. Goal: To conduct health facility-based surveillance for STDs to inform design of a control program and to provide baseline measures for evaluation of interventions. Study Design: Surveillance system for patients with STD syndromes in public and private sector health facilities in Hlabisa, South Africa. Results: Over a 5-month period, 4,781 patients with an STD were reported, 3,126 (65%) by clinics and 1,655 (35%) by general practitioners; 2,582 (54%) were in men. Most were diagnosed with a single syndrome. Discharge was most common (49% of both male and female patients), followed by ulcer (36% of men and 14% of women). Mean symptom duration was 18 days for women and 10 days for men (p < 0.0001). A quarter reported having another STD in the previous 3 months. The highest age-specific incidence was estimated at 16.4% among women 20 to 24 years of age. Conclusions: The burden of STDs is high in rural South Africa. There is considerable scope for improved disease control, and the private sector has an important role to play.