For the last seven decades, cleaning symbiosis in the marine environment has been a research field of intrigue. There is substantial evidence that, by removing undesired items from their client fishes, cleaner organisms have positive ecosystem effects. These include increased fish recruitment, abundance and enhanced fish growth. However, the intimate association and high frequency of interactions between cleaners and clients potentially facilitates pathogen transmission and disease spread. In this review, we identify knowledge gaps and develop novel hypotheses on the interrelationship between parasites, hosts and the environment (disease triangle concept), with a particular emphasis on the potential role of cleaner organisms as hosts and/or transmitters of parasites. Despite evidence supporting the positive effects of cleaner organisms, we propose the cleaners as transmitters hypothesis; that some parasites may benefit from facilitated transmission to cleaners during cleaning interactions, or may use cleaner organisms as transmitters to infect a wider diversity and number of hosts. This cost of cleaning interactions has not been previously accounted for in cleaning theory. We also propose the parasite hotspot hypothesis; that parasite infection pressure may be higher around cleaning stations, thus presenting a conundrum for the infected client with respect to cleaning frequency and duration. The impact of a changing environment, particularly climate stressors on cleaners’ performance and clients’ cleaning demand are only beginning to be explored. It can be expected that cleaners, hosts/clients, and parasites will be impacted in different ways by anthropogenic changes which may disrupt the long-term stability of cleaning symbiosis.

在过去的七十年中，清洁海洋环境中的共生一直是引起人们兴趣的研究领域。有大量证据表明，通过从其客户鱼类中去除不需要的物品，清洁生物会对生态系统产生积极影响。这些措施包括增加鱼类招募，丰富和增加鱼类生长。但是，清洁工和客户之间的密切联系和频繁互动可能会促进病原体传播和疾病传播。在这篇综述中，我们发现了知识缺口，并就寄生虫，宿主与环境之间的相互关系提出了新的假设（疾病三角概念），并特别强调了清洁生物作为寄生虫的宿主和/或传播者的潜在作用。尽管有证据支持清洁生物的积极作用，清洁工作为传播者的假设; 一些寄生虫可能会受益于清洁互动过程中向清洁剂的便利传播，或者可能会使用清洁生物作为传播体来感染更广泛的多样性和数量的宿主。清洁理论上尚未考虑清洁交互作用的成本。我们还提出了寄生虫热点假说; 清洁站周围的寄生虫感染压力可能会更高，从而在感染频率和持续时间方面给受感染的客户带来难题。不断变化的环境（尤其是气候压力因素）对清洁器性能和客户清洁需求的影响才刚刚开始探索。可以预料的是，人为改变可能会以不同的方式影响清洁工，寄主/服务对象和寄生虫，这可能会破坏清洁共生的长期稳定性。