SR 59 begins at an intersection with SR 47 in the northern part of the town of Drakes Branch opposite Saxkey Road. The state highway heads northeast from SR 47 as Gethsemane Church Avenue, then becomes unnamed after leaving the town limits. SR 59 follows the height of land between Twittys Creek to the south and Ash Camp Creek to the north; both streams empty into Roanoke Creek west of Drakes Branch. The state highway begins to parallel a Norfolk Southern Railwayrail line as it approaches Keysville. SR 59 enters the town of Keysville as Merry Oaks Drive then reaches its northern terminus at SR 40 west of downtown Keysville.