Communicable diseases surveillance is essential for directing policy development. In most regards, sexually transmissible diseases (STD) surveillance is no different to surveillance for other communicable diseases. There are nevertheless several aspects of STDs that have to be taken into consideration in designing and managing surveillance activities. These include particular confidentiality concerns associated with STDs, the disproportionate morbidity STDs confer on marginalised or stigmatised populations, and clinical limitations due to the requirement of often uncomfortable genital examinations for the diagnosis of many STDs. Furthermore, interpretation of STD surveillance data requires information on sexual behaviour which is not routinely collected for other types of surveillance. In addressing new STD surveillance strategies the key public health questions that can be answered by surveillance need to be defined. These include the prevalence of individual STDs among the total population and specific population subgroups, the rates of symptomatic versus asymptomatic disease, treatment seeking levels, and antibiotic sensitivity patterns for some agents. This article describes possible STD surveillance methodologies to meet these demands.