Serodiscordant Couple Overview

Definition and Risks

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

A serodiscordant couple is a couple who have different blood markers or blood test results for a particular disease. Uninfected partners of people who have sexually transmitted diseases (STDs), especially those that aren't curable, are at high risk of becoming infected. 

Preventive interventions can be very effective if used consistently. Many of the studies of new HIV prevention technologies have included serodiscordant couples.

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 than 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.

Some methods of prevention, such as pre-exposure prophylaxis (PrEp), are more effective in preventing infection during anal sex than in vaginal intercourse.

Short Term vs Long-Term HIV Risk for Serodiscordant Couples

There are a number of ways for serodiscordant couples to reduce the risk of HIV transmission to the uninfected partner. 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 (TasP), condoms, and circumcision is more effective than using just one.

Preventing HIV Transmission in Serodiscordant Couples

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.

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 still practice safe sex, such as using condoms.

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 is designed to reduce your viral load, while minimizing your side effects. 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?

Serodiscordant couples 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 use another method to get pregnant.

When the female partner is the one who is HIV positive, she can be inseminated with her partner's sperm using artificial insemination, in vitro fertilization, or intrauterine insemination. With these methods, partners don't need to have unprotected sex to conceive.

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 who has HIV gets pregnant, there are recommendations for reducing the risk that her infant will be born HIV positive. The most important is to have adequate prenatal care and appropriate treatment for HIV. In addition, the infant may need to be treated after birth. For women whose HIV is not fully suppressed, a cesarean section might be scheduled 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 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.