A 5-week mesocosm experiment was conducted to investigate the toxicity of titanium dioxide nanoparticles (TiO2NPs) to periphytic algae in an environmentally-realistic scenario. We used outdoor experimental streams to simulate the characteristics of central Texas streams receiving large discharges of wastewater treatment plant effluent during prolonged periods of drought. The streams were continually dosed and maintained at two concentrations. The first represents an environmentally relevant concentration of 0.05 mg L-1 (low concentration). The second treatment of 5 mg L-1 (high concentration) was selected to represent a scenario where TiO2NPs are used for photocatalytic degradation of pharmaceuticals in wastewater. Algal cell density, chlorophyll-a, ash-free dry mass, algal assemblage composition, and Ti accumulation were determined for the periphyton in the riffle sections of each stream. The high concentration treatment of TiO2NPs significantly decreased algal cell density, ash-free dry mass, and chlorophyll-a, and altered algal assemblage composition. Decreased abundance of three typically pollution-sensitive taxa and increased abundance of two genera associated with heavy metal sorption and organic pollution significantly contributed to algal assemblage composition changes in response to TiO2NPs. Benefits of the use of TiO2NPs in wastewater treatment plants will need to be carefully weighed against the demonstrated ability of these NPs to cause large changes in periphyton that would likely propagate significant effects throughout the stream ecosystem, even in the absence of direct toxicity to higher trophic level organisms.