- Pesticides are a major stressor for stream ecosystem health. They enter surface waters from diffuse agricultural sources but also from point sources such as municipal wastewater treatment plants (WWTPs). However, to date, no studies have focused on the ecological effects of pesticide-contaminated WWTP effluent on macroinvertebrate communities. On the basis of governmental monitoring data of 328 sites in Hesse, Germany, we identified insecticidal long-term effects on the structure of the macroinvertebrate community up to 3 km downstream of WWTPs. The effects were quantified using the trait-based SPEARpesticides index, which has been shown to be an effective tool for identifying community effects of pesticide contamination. In addition, based on the German Saprobic Index, we revealed that WWTPs are still an important source of oxygen-depleting organic pollution, despite the extensive technological improvements in wastewater management over several centuries. In general, our findings emphasize the need to take municipal WWTPs into consideration in the management of river basins under the EU Water Framework Directive to achieve good ecological and chemical status for European streams and rivers.