Even in countries with extensive sanitation systems, outbreaks of waterborne infectious diseases are being reported. Current tendencies, such as the growing concentration of populations in large urban conurbations, climate change, aging of existing infrastructures, and emerging pathogens, indicate that the management of water resources will become increasingly challenging in the near future. In this context, there is an urgent need to control the fate of fecal microorganisms in wastewater to avoid the negative health consequences of releasing treated effluents into surface waters (rivers, lakes, etc.) or marine coastal water. On the other hand, the measurement of bacterial indicators yields insufficient information to gauge the human health risk associated with viral infections. It would therefore seem advisable to include a viral indicator—for example, somatic coliphages—to monitor the functioning of wastewater treatments. As indicated in the studies reviewed herein, the concentrations of somatic coliphages in raw sewage remain consistently high throughout the year worldwide, as occurs with bacterial indicators. The removal process for bacterial indicators and coliphages in traditional sewage treatments is similar, the concentrations in secondary effluents remaining sufficiently high for enumeration, without the need for cumbersome and costly concentration procedures. Additionally, according to the available data on indicator behavior, which is still limited for sewers but abundant for surface waters, coliphages persist longer than bacterial indicators once outside the gut. Based on these data, coliphages can be recommended as indicators to assess the efficiency of wastewater management procedures with the aim of minimizing the health impact of urban wastewater release in surface waters.