It is located between Jeffreys Bay and Port Elizabeth and the Gamtoos River Mouth Nature Reserve is in the area.

Saartjie Baartman - the "Hottentot Venus" - was born around 1789 in the vicinity of the Gamtoos river.

[3] During the floods of October 1867, according to John Croumbie Brown, the level of water in some parts of the river rose by up to 21 m (70 ft).

Presently this river is part of the Fish to Tsitsikama Water Management Area.

In 1995 specimens of the Cape galaxias (Galaxias zebratus), a South African fish species endemic to the Cape Floristic Region, were found in the Krom River and subsequently they were also found in the Gamtoos River system.