I know that the rives and streams had less man made pollutants, but what about parasites and such.
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A mixture of the obvious things you’re considering.
They would know, even if they didn’t understand the “why”, that certain bodies of water were safer to drink than others. A clear, cool, running stream would be safer than fetid stagnant water for example.
Many cultures did eventually figure out boiling the water or using it for fermentation would make it safer.
People also got sick, that was just a thing. Usually they got better, sometimes they died. But in general “being sorta sick” was just more normal back then, you just had larger proportions of the society on the DL at any given time in general.
Finally, there is some level of acquired immunity to certain illnesses and local people might just progressively get better at handling the local microbes.
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