Background: Tuberculosis (TB) is currently one of the greatest problems in public health. Mycobacterium tuberculosis infects about one third of the world's population, of whom more than 80% are living in developing countries. The incidence and prevalence of TB are very different in various parts of Iran and also throughout the world. Golestan province is one of the areas in the country where the risk of TB is the highest because of its ethnically varied population and special location. We aimed to describe the prevalence of TB and related demographic data in Golestan province (northeast of Iran). Methods: We collected all data of patients with TB who registered in 2005 and 2006 in each of the 11 districts of Golestan province. Data were entered into the computer database and age-specific incidence rates per 100 000 population were calculated. Results: There were 321 new smear-positive cases. The incidence and prevalence of TB were 20.88 and 38.15 per 100 000 population, respectively. The male to female ratio was 0.96. Relapse of TB was reported in 20 patients. We found 141 cases of extrapulmonary TB, with a significant predominance in women. The organ most frequently involved in extrapulmonary TB was the lymph nodes. Generally, smear-negative TB was more common in men and extrapulmonary TB was more common in women. Conclusion: The incidence and prevalence of TB were higher in Golestan province in comparison with other provinces in Iran. We suggest using improved screening strategies and better education about TB for high-risk groups and physicians.