Pathogenic Leptospira, the causative agents of leptospirosis, are mainly associated with tropical freshwaters, but little is known about their fate in the environment. This study analyzed the distribution of pathogenic Leptospira genomes in 22 tropical coastal streams using quantitative polymerase chain reaction (qPCR). Statistical analyses were conducted to understand pathogenic Leptospira associations with water quality parameters, land use, microbial source tracking (MST) markers, and fecal indicators. Results indicated that pathogenic Leptospira genomes were widespread in O'ahu coastal streams during the Hawai'ian rainy season, with slightly higher concentrations in December when compared with March. Leptospira showed a strong positive association to turbidity, a finding consistent with studies showing increased Leptospira survival when aggregated to particles. Positive correlations to salinity may also indicate survival of Leptospira in relatively saline stream waters. A positive association to the human Bacteroidales fecal marker, no correlation to pig or cow Bacteroidales markers, and a negative association to agricultural land coverage may suggest human or other non-agricultural animal sources of Leptospira (e.g., rats or dogs). Future studies of Leptospira in the Hawai'ian environment are recommended to investigate Leptospira survival in saline waters, to determine both primary and secondary Hawai'ian animal hosts of Leptospira, and to correlate environmental exposures with epidemiological studies of leptospirosis.