Tuberculosis (TB) remains a global public health concern and challenges the national structures for infection control and health care, as well as international institutions, to develop and implement new strategies to control and combat this disease. In our report, we investigated the TB epidemiological situation in St. Petersburg and the countries around the Baltic Sea using national epidemiological statistics and epidemiological reports of international organizations, such as the WHO and Euro-TB. After the disintegration of the Soviet Union, a steep increase in tuberculosis was seen in the Russian Federation, St. Petersburg and the Baltic States, after which it stabilized at levels significantly higher compared to the Nordic countries. Moreover, the epidemiological situation in St. Petersburg and the Baltic States was aggravated by the emergence and spread of TB/HIV coinfection, as well as that of drug-resistant M. tuberculosis, which imposed further difficulties in gaining control of TB. During the studied period, the TB burden in neither St. Petersburg nor Baltic States has had a significant impact on the epidemiology in the low TB burden neighbouring countries around the Baltic Sea.