To protect bather health at recreational beaches, fecal indicator bacterial standards are used to monitor water quality, and waters exceeding the standards are subsequently closed to bathers. However beachgoers are also in contact with beach sands, the sanitary quality of which is not included within beach monitoring programs. In fact, sands and sediments provide habitat where fecal bacterial populations may persist, and in some cases grow, in the coastal zone. Specific pathogens are less well studied in beach sands and sediments, but there is a body of evidence that they too may persist in these environments. This paper reviews the current state of knowledge regarding the abundance and distribution of fecal indicator bacteria and pathogens in beach sands of diverse climatological regions, and at beaches subjected to varied levels of anthropogenic impact. In all regions fecal indicator bacteria are nearly ubiquitous in beach sands, and similar relationships emerge among fecal indicator abundance in dry sand, submerged sands, and water. Taken together, these studies contextualize a potential public health issue and identify research questions that must be addressed in order to support future policy decisions.