Secondary syphilis can develop in approximately ¼ of patients with untreated infections and presents with systemic signs and symptoms including fatigue, fever, myalgia, loss of appetite and lymphadenopathy. Involvement of the gastrointestinal tract, liver, kidneys, musculoskeletal system, CSF and eyes can also occur. Skin findings include a diffuse symmetric rash of the trunk, extremities and palms and soles with occasional involvement of the oral and perineal mucosa. Patients can also present with alopecia. If untreated, this stage generally resolves spontaneously, may relapse or develop into tertiary syphilis.