Taenia solium taeniasis and cysticercosis are known to be endemic in Guatemala but no studies had been undertaken in rural communities where transmission was thought to occur. Two adjacent communities, Quesada and El Jocote, in the Department of Jutiapa were selected. The former had considerably better sanitary infrastructure than the latter. The seroprevalence of antibodies detected in humans by immunoblot to T. solium metacestode glycoprotein antigens was 10% and 17% and the prevalence of intestinal taeniasis was 1% and 2.8% in the two villages, respectively. Both of these represented statistically greater rates in El Jocote. Females were significantly more likely to be seropositive than males in the study as a whole. The majority of cases of intestinal taeniasis were due to T. solium. Cases of intestinal taeniasis were significantly more likely to be anti-cysticercus antibody-positive than the general population. Epilepsy was recorded in 2.8% and 2.9% of the populations of Quesada and El Jocote, respectively. Follow-up of this group and a group of asymptomatic individuals by computed tomography scan indicated that individuals with a history of seizures had a higher rate of abnormalities suggestive of neurocysticercosis. Cysts were present in the tongues of 4% of live pigs sampled in Quesada and 14% in El Jocote. In these two communities, which are probably representative of many others in Guatemala, T. solium appeared to be a significant public health problem.