Serodiscordant Couple Overview

Definition and Risks

The term serodiscordant couple is usually used to refer to relationships where one partner is living with HIV and the other is not. Technically speaking, however, it can be used for any relationship where one person's blood tests positive for a virus and the other's does not.

A couple holding hands while talking with their doctor
Sneksy / iStockphoto

It is thus also often used to refer to couples where one person is living with herpes and the other is not, or where one is living with hepatitis and the other is not.

Word Origins

The term serodiscordant is made up of two roots:

  1. Sero—meaning blood
  2. Discordant—meaning different or non-matching

Therefore a serodiscordant couple is a couple who have different blood. More specifically, it's a couple who has different blood markers or blood tests for a particular disease.

Doctors and scientists working with infectious diseases, such as HIV and hepatitis C, spend a lot of time thinking about individuals in serodiscordant couples. This is because the uninfected partners in such couples are pretty much the definition of high risk. 

There is, at least in couples who are having sex, a known potential route of infection. That means that individuals in serodiscordant relationships are the perfect target for prevention interventions. 

These couples are also a great population in which to do treatment and prevention research. Many of the studies of new HIV prevention technologies have been performed in heterosexual and homosexual serodiscordant couples.

Why? Because doctors know that the uninfected individuals in these relationships are likely to be exposed to HIV, which gives them the biggest bang for their buck. They have the potential to observe larger effects while treating fewer people.

HIV Risks for Serodiscordant Couples - Gay and Straight

All serodiscordant couples can potentially transmit HIV between them. However, the risks are significantly different for straight couples and for gay men. Why? Because gay men are at an elevated risk of HIV in general. HIV is more likely to spread during anal sex than during vaginal sex, and gay men are more likely to have unprotected anal sex. Methods of prevention, such as pre-exposure prophylaxis, are also less effective in preventing infection during anal sex. So, all in all, there are a number of reasons why uninfected individuals in heterosexual serodiscordant couples are at lower risk than those in male homosexual serodiscordant couples.

Short Term vs Long-Term HIV Risk for Serodiscordant Couples

In the short term, there are a number of ways for people in serodiscordant couples to reduce their HIV risk. In the long-term, it's helpful to take a belt and suspenders approach. Research suggests that using multiple methods to prevent HIV, such as treatment as prevention, condoms, and circumcision is more effective than using just one. That's true for a number of reasons. One of the biggest is that if you forget one option, such as your medication, you still have a backup.

Preventing HIV Transmission in Serodiscordant Couples

Prevention and treatment interventions, such as treatment as prevention (TasP) and pre-exposure prophylaxis (PrEP), have often been targeted at members of serodiscordant couples because they are considered to be at high-risk of either acquiring HIV or passing it on. Treatment as prevention works on the principle that people whose HIV is well treated are less likely to transmit the virus to their sexual partners. In fact, people with an undetectable viral load are extremely unlikely to transmit HIV through sexual contact. (Although it is still recommended that couples use barriers and practice safer sex.)

Pre-exposure prophylaxis, or PrEP is another way to reduce the risk of HIV transmission in serodiscordant couples. With PrEP, the uninfected partner is treated with an HIV drug. Using PrEP has been shown to reduce the risk that someone will become infected with HIV even if they are exposed. However, PrEP isn't perfect. Therefore, people should consider still practicing safer sex.

Treating HIV in Serodiscordant Couples

When you are in an HIV serodiscordant couple, the goals of HIV treatment are the same as when you're single. Effective treatment will be designed to reduce your viral load while minimizing your side effects. Doing this is both the best thing for your health and the best thing for the health of your partner(s).

Can Heterosexual Serodiscordant Couples have Children?

Couples where one partner has HIV may have some concerns about having children. Having HIV isn't a reason not to have children. However, it is a reason to think about the best way to conceive, carry a pregnancy, and give birth. After all, you can't get pregnant if you're having sex with condoms. Therefore, if you're using condoms to protect yourself from HIV, you'll need to try another method.

Where the female partner is the one who is HIV positive, the safest option is relatively straightforward. She can be inseminated with her partner's sperm using artificial insemination, in vitro fertilization, or intrauterine insemination. Those methods mean that partners don't need to have unprotected sex to conceive. Things are more difficult if the male partner is the one who is HIV positive. Options include using a sperm donor and/or washing sperm. Men can also make certain that their viral load is suppressed as fully as possible before having unprotected sex in an attempt to conceive.

If a woman with HIV gets pregnant, there are things she can do to reduce the risk that her infant will be born HIV positive. The most important is to have adequate prenatal care where she is appropriately treated for HIV. In addition, doctors may want to treat the infant after birth. For women whose HIV is not fully suppressed, doctors may also want to schedule a cesarean section before the membranes rupture ("water breaks"). This has the potential to reduce the risk that the baby will be exposed to HIV during delivery.

A Word From Verywell

Many people in serodiscordant couples have long, happy, and healthy relationships. The trick is to be realistic about risks and how you're willing to manage them. That's the only way to make good decisions in both the doctor's office and the bedroom.

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Article Sources
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  1. Muessig KE, Cohen MS. Advances in HIV prevention for serodiscordant couples. Curr HIV/AIDS Rep. 2014;11(4):434-446. doi:10.1007/s11904-014-0225-9

  2. Stanford Health Care. Risk of exposure to HIV/AIDS.

  3. CDC. Prevention. Updated December 2, 2019.

  4. CDC. HIV treatment as prevention. Updated November 12, 2019.

  5. CDC. PrEP. Updated December 3, 2019.

  6. U.S. Department of Health and Human Services. Preconception counseling and care for women of childbearing age living with HIV. Reproductive options for couples when one or both partners are living with HIV.

  7. U.S. Department of Health and Human Services. HIV medicines during pregnancy and childbirth. Updated January 29, 2020.

Additional Reading
  • U.S. Department of Veterans Affairs. HIV.