Eutrophication is the most widespread water quality issue globally. To date, most efforts to control eutrophication have focused on reductions of external nutrient inputs, yet importance of nutrient stoichiometry and subsequent shift in plankton composition in aquatic ecosystem has been largely neglected. To address eutrophication, improved sanitation is one of the United Nations Sustainable Development Goals, spurring the constructions of wastewater treatment facilities that have improved water quality in many lakes and rivers. However, control measures are often targeted at and effective in removing a single nutrient from sewage and thus are less effective in removing the others, resulting in the changes of nutrient stoichiometry. In general, more effective phosphorus removal relative to nitrogen has occurred in wastewater treatment leading to substantial increases in N/P ratios in effluent relative to the influent. Unfortunately, high N/P ratios in receiving waters can impose negative influences on ecosystems. Thus, long-term strategies for domestic wastewater management should not merely focus on the total reduction of nutrient discharge but also consider their stoichiometric balances in receiving waters.