Onsite wastewater treatment systems, such as septic systems, serve 20% of U.S. households and are common in areas not served by wastewater treatment plants (WWTPs) globally. They can be sources of nutrients and pathogen pollution and have been linked to health effects in communities where they contaminate drinking water. However, few studies have evaluated their ability to remove organic wastewater compounds (OWCs) such as pharmaceuticals, hormones, and detergents. We synthesized results from 20 studies of 45 OWCs in conventional drainfield-based and alternative onsite wastewater treatment systems to characterize concentrations and removal. For comparison, we synthesized 31 studies of these same OWCs in activated sludge WWTPs. OWC concentrations and removal in drainfields varied widely and depended on wastewater sources and compound-specific removal processes, primarily sorption and biotransformation. Compared to drainfields, alternative systems had similar median and higher maximum concentrations, reflecting a wider range of system designs and redox conditions. OWC concentrations and removal in drainfields were generally similar to those in conventional WWTPs. Persistent OWCs in groundwater and surface water can indicate the overall extent of septic system impact, while the presence of well-removed OWCs, such as caffeine and acetaminophen, may indicate discharges of poorly treated wastewater from failing or outdated septic systems.