Background: A significant shift has occurred in public health over the past few decades which lead to evolving of genetic disorders and Sexually Transmitted Infections (STIs) as major causes of morbidity and mortality. Objective: To assess the awareness, issues of premarital counseling among undergraduate students of Karachi. Materials & Methods: A cross sectional descriptive study, with a sample size of 300 students from four institutions of Karachi, namely Dow Medical College (DMC), Sindh Medical College (SMC) Karachi University (KU) & Institute of Business Management (IBA). Tool of assessment used was structured questionnaire with 13 questions, focused on awareness regarding inter-cousin marriage, hereditary diseases, Sexually Transmitted Infections (STIs), contraception, and effect of counseling on divorce rate. Data was analyzed using SPSS version 16. Results: Statistical analysis showed 76.3% students believed that it is beneficial to go for pre marital counseling, and 79.3% students thought that Premarital Counseling could bring down the divorce rate. 68.7% students were of the opinion that Thalassemia is a common genetic disease and 44.3% believed that HIV is the commonly screened disease. Conclusion: This study concludes that undergraduate students of Karachi, Pakistan recognizes Premarital Counseling as a beneficial tool for the prevention of common genetic and sexually transmitted infections and efforts should be made to implement Health Promotion Programs supported with ante-natal and genetic testing screening facilities.