- Abstract Millions of decentralized graywater-reuse systems are operating worldwide. This water is directly accessible to household inhabitants, raising environmental and public health concerns. Graywater may contain a variety of harmful organisms, the types and numbers of which vary with source-type, storage time, and background levels of infection in the community source. In this review, we find that most studies indicate high amounts of microbial pathogens in raw graywater and therefore treatment and disinfection are recommended to lower possible health risks. Where these recommendations have been followed, epidemiological and quantitative microbial risk-assessment studies have found negligible health risks of bacterial pathogens in treated graywater. Chlorine is currently suggested as the most cost-effective disinfection agent for inactivating graywater bacterial pathogens and preventing regrowth. Various studies demonstrate that the introduction and diversity of pathogenic bacteria in the soil via irrigation can be affected by several factors, but treated graywater may not be a major contributor of bacterial contamination or antibiotic resistance. However, an accurate assessment of the infectious capabilities, exposure pathways, and resistance of specific pathogens, particularly viruses and antibiotic-resistant bacteria found in treated graywater after disinfection, as well as in the graywater piping, irrigated soils, plants, and associated aerosols is largely lacking in the literature. In addition, research shows that fecal bacterial indicators might not reliably indicate the presence or quantities of pathogens in graywater and thus, the indicator standard for graywater contamination should be revised.