Can You Get Syphilis Without Having Sex?

Medically reviewed on July 19, 2023 by Amy Harris, MS, RN, CNM. To give you technically accurate, evidence-based information, content published on the Everlywell blog is reviewed by credentialed professionals with expertise in medical and bioscience fields.

Table of contents

• How Can You Get Syphilis?
• Mother to Baby Syphilis Transmission
• Other Less-Likely Ways to Get Syphilis Without Having Sex
• How to Lower Your Risk Of Getting Syphilis From Having Sex
• Who’s at Greatest Risk for Getting Syphilis from Sex?
• What Are the Symptoms of Syphilis?
• Check for Syphilis with Everlywell
• Related Content

Syphilis is a sexually transmitted infection (STI) caused by a bacterium called Treponema pallidum. A syphilis infection can cause a range of symptoms including sores and rashes. Untreated syphilis can cause organ, brain, heart, and eye damage. [1]

While the bacterium is primarily transmitted through sexual contact, a mother who is infected with syphilis in pregnancy can pass the infection on to her baby in utero (congenital syphilis). [2]

So, can you get syphilis without having sex? Yes – a syphilis infection is possible without having sex. Let’s explore how.

How Can You Get Syphilis?

Syphilis is transmitted most easily and frequently through sexual activity [3]. Any activity allowing the exchange of bodily fluids like semen, saliva, blood, or vaginal discharge or when moist skin areas (genitals, mouth, anus) touch is fair game for syphilis transmission.More specifically, you can become infected with syphilis if you [3]:

• Have unprotected penetrative vaginal, anal, or oral sex
• Kiss or lick the anus
• Share unwashed or unprotected sex toys
• Touch genitals

Syphilis spreads from person to person by direct contact with a syphilitic sore, known as a chancre. Chancres can occur in, on, or around the penis, vagina, anus, rectum, and lips or mouth. [1] To the last point, syphilis can be spread without penetration or ejaculation. You can become infected with syphilis by kissing a partner who has a sore on their mouth, although this mode of transmission is less common [4]

Mother to Baby Syphilis Transmission

The main way people contract syphilis without having sex is when a pregnant mother with syphilis transmits the bacteria to her child in utero via placental blood flow or through direct contact with an infected lesion during childbirth. [5] This is called congenital syphilis.

Sadly, congenital syphilis is entirely preventable. Thus, the U.S. Centers for Disease Control recently increased the frequency of syphilis testing of all pregnant people, advising testing everyone at their first prenatal visit and those at higher risk or living in areas with more syphilis cases, again at 28 weeks gestation and at delivery. [1]

Syphilis infection in pregnancy can have severe health effects. Mothers are most likely to transmit syphilis to their babies if they get infected with syphilis during their third trimester. Transmission rates are lower in women with later stages of syphilis infection. [2] In some cases, congenital syphilis can cause miscarriage or stillbirth. If the pregnancy continues, the baby may be born prematurely or underweight. Other times, the baby may not survive –untreated syphilis in pregnant people results in infant death 40 percent of the time. [2]

A baby born alive with syphilis may not have any signs or symptoms of disease at first, but serious complications can develop within a matter of weeks. [1] Penicillin is the only antibiotic that can treat syphilis in the fetus and newborn.1 Early identification and treatment of babies with syphilis identified at birth or shortly thereafter can prevent death and serious complications 98 percent of the time. [6] Babies with congenital syphilis may experience life-threatening symptoms or conditions, including but not limited to [2]:

• Bone deformities
• Anemia
• Jaundice
• Hepatosplenomegaly (enlargement of the liver and spleen)
• Deafness
• Blindness
• High cholesterol
• Meningitis
• Inflammation

Other Less-Likely Ways to Get Syphilis Without Having Sex

Besides congenital syphilis, there are very few other ways to transmit syphilis without having sex. The CDC states that you can not get a syphilis infection from “casual contact” with the following objects [4]:

• Toilet seats
• Doorknobs
• Swimming pools
• Hot tubs
• Bathtubs
• Sharing clothing, or eating utensils

As noted, other non-penetrative sexual activity and using contaminated sex toys can rarely result in syphilis infections. [3]

Syphilis transmission did occur in the past through blood transfusions and organ transplants. [3] In developed parts of the world and places with established health care systems, blood screening systems, or refrigeration of blood products, syphilis transmission can occur. There are case reports of work-based exposure to syphilis through an accidental surgical injury, but again this risk is very low. [3]

How to Lower Your Risk Of Getting Syphilis From Having Sex

Given that syphilis is transmitted most frequently and easily through sexual activity, there are several steps you can take to reduce the chances that you will become infected with syphilis [1]:

1. Prioritize monogamous relationships and minimize the number of your sexual partners.
2. Get tested for all STIs each time you have a new partner or if you have any symptoms or reason to believe your partner has had other sexual partners.
3. Use condoms and dental dams every time you have oral, anal, or vaginal intercourse.
4. Clean and sterilize all sex toys according to instructions and do not share sex toys.

Who’s at Greatest Risk for Getting Syphilis from Sex?

Research shows that some people are more likely to have a syphilis infection than others. These people are also more likely to:

1. Be male or assigned male at birth (AMAB). [6]
2. Be infected with human immunodeficiency virus (HIV). [1]
3. Have multiple sexual partners.
4. Have unprotected sex.
5. Be gay, bisexual, or men having sex with men (MSM).6One study reported that that among 274 cases of early syphilis, 94 percent of participants were MSM, and 36.3 percent had HIV. [7]

Researchers concluded that this crossover could be due to shared sexual behaviors within both the HIV-positive and MSM communities, such as engaging in unprotected sexual activity, substance use during sex, or having multiple sexual partners. [7]

That said, engaging in unprotected or unsafe sex can put anyone at a higher risk of contracting syphilis and other STIs, no matter their sexual orientation, gender expression, or sexual health status.

What Are the Symptoms of Syphilis?

Syphilis infection progresses through four stages – primary syphilis, secondary syphilis, latent syphilis, and tertiary syphilis stage. You can have different symptoms in each stage and the progression from one stage to another can take weeks, months, and even years. [1] Not everyone infected with syphilis will have (or notice) their symptoms, thus this STI continues to spread widely.

Primary Stage

Once you are infected with syphilis, it can take anywhere from 10 - 90 days to develop the first symptom – a painless, round, sore called a chancre at the site of infection. [1] Many people mistake chancres for a harmless bump, ingrown hair or pimple. This first symptom can be hard to notice because it is painless and may be located in hard-to-see areas such as the vagina or anus.

The chancre heals after three to six weeks, regardless of whether or not you receive the treatment for syphilis, the antibiotic penicillin. [1] Even if your chancre goes away, you still have syphilis and can infect sexual partners if you do not get treatment. Depending on the transmission site, you may also have the chancre on your mouth (in the case of syphilis tongue) or near your eyelid in cases of ocular syphilis. Where the bacterium infects the eye, the sore may appear on or near the eyelid. [9]

Secondary Stage

If not treated with penicillin, you then enter the secondary stage of syphilis. The most common symptom of secondary syphilis is a body rash. This rough and red-appearing rash does not itch, and tends to concentrate around the site of infection, but can also break out on your arms, palms of your hands, soles of your feet, and on your legs. [1]

Some people in the secondary stage of syphilis also develop wart-like bumps called condyloma lata, that are large, raised, gray or white lesions. People tend to find these bumps in warm, moist parts of their body like the mouth, underarms or groin. [1]

Secondary stage symptoms (including this syphilis rash and condyloma lata) can last 2 to 6 weeks at a time and may come and go for up to 2 years. [10] Some people develop secondary syphilis symptoms while they still have their chancre. Other secondary syphilis symptoms mimic many other common illness symptoms such as fevers, swollen lymph nodes, muscle aches, and sore throat.1 People may attribute such symptoms to COVID-19, flu, or a common cold before considering testing for syphilis.

Latent & Tertiary Stages

Following the secondary syphilis stage, syphilis can become latent (meaning no symptoms)—even for years. However, if left untreated, the symptoms will return and can become more severe as the infection progresses throughout the body. The longer you have syphilis without getting treatment, the more damage it can cause to your body. The tertiary syphilis stage is marked by potential organ failure and damage to the nervous system, including the brain, spinal cord, and eyes. Syphilis in this stage can be fatal. [1]

Neurosyphilis and ocular syphilis may also be present during this stage and others, depending on the initial point of infection:

• Neurosyphilis – The infection spreads to the brain and spinal cord and may lead to meningeal syphilis (headache, stiff neck, nausea, and vomiting), meningovascular syphilis (headache, stiff neck, nausea, vomiting, and risk of stroke), general paresis (personality or mood changes), or tabes dorsalis (muscle failure and pain and impaired balance). In some cases, neurosyphilis may be asymptomatic. [8]
• Ocular syphilis – The infection infects the structures of the eye and may spread to the brain via the optic nerve, causing neurosyphilis. This can lead to inflammation, lesions or sores on the eyelids, discoloring of the eye, and possible blindness without treatment. [9]

Check for Syphilis with Everlywell

The bacteria causing syphilis is primarily transmitted through sexual activity or contact; however, it may also spread from a mother to their baby during pregnancy. As such, it’s critical to practice safe sex and get tested for STIs regularly to prevent the transmission of syphilis and avoid untreated syphilis.

The Everlywell at-home Syphilis Test analyzes a blood sample for antibodies that fight against the Treponema pallidum bacterium through a CLIA-certified laboratory. Once a licensed physician reviews your sample, you’ll receive your results through a HIPAA-compliant and confidential digital system. If your results are abnormal, we’ll connect you to a clinician to discuss a treatment plan, which typically involves follow-up testing to confirm your diagnosis, the stage of syphilis you are in, and the prescription of penicillin.

If you want more information about your sexual health, schedule an online STD appointment today. When you schedule your appointment through our telehealth service, we’ll pair you with a licensed clinician who can address your concerns.

Discover your next steps with Everlywell.

Related Content

Syphilis in Pregnancy: What You Need to Know

Syphilis Tongue: Here's What to Know

Ocular Syphilis: A Quick Guide

References

1. Syphilis – CDC Detailed Fact Sheet. CDC. Published April 11, 2023. URL. Accessed June 19, 2023.
2. Congenital syphilis – Fact Sheet. CDC. URL. Accessed June 24, 2023.
3. Stoltey JE, Cohen SE. Syphilis transmission: a review of the current evidence. Sex Health. 2015;12(2):103-109. doi:10.1071/SH14174. URL. Accessed June 12, 2023.
4. Syphilis – Basic CDC Fact Sheet. CDC. URL. Accessed June 23, 2023.
5. Fang J, Partridge E, Bautista GM, Sankaran D. Congenital Syphilis Epidemiology, Prevention, and Management in the United States: A 2022 Update. Cureus. 2022;14(12):e33009. Published 2022 Dec 27. doi:10.7759/cureus.33009. URL. Accessed June 12, 2023.
6. Syphilis statistics. CDC. URL. Accessed June 24, 2023.
7. Arando M, Fernandez-Naval C, Mota-Foix M, Martinez D, Armengol P, Barbera M, Esperalba , Vall-Mayans, M. Published August 16, 2019. URL. Accessed June 19, 2023.
8. Neurosyphilis. NIH. Published January 20, 2023. URL. Accessed June 19, 2023.
9. Koundanya V, Tripathy K. Syphilis Ocular Manifestations. StatPearls. Published February 22, 2023. URL. Accessed June 19, 2023.
10. What is syphilis. Planned Parenthood. URL. Accessed June 24, 2023.