RTCs are one of the leading causes of premature deaths and acquired disabilities globally. It has been established that a well-maintained and high-performing RTSs is a cost effective means of optimizing road safety. In the STM, RTSs neglect is a commonplace, yet the extent of the situation is unknown. This study therefore aimed to assess the state of RTSs in the STM. With the aid of a detailed road map, inventory of RTSs as well as their conditions was visually evaluated in the STM. In all, 116 RTSs were visually assessed. Of these, only a little over one-half (52.6%) was present. 69% of the RTSs present were in poor condition. The road network in the STM is thus poorly equipped with RTSs, and this presents a significant traffic safety challenge to road users. An innovative, comprehensive, systematic, and regular maintenance programme that is adequately resourced be instituted, to secure long-term performance of road traffic signs in the metropolis, in Ghana's quest at maintaining a healthy and productive population.