Between three to five days after exposure, the symptoms will appear in the genital area, rectal area, or in the throat, depending on the sexual activity. Up to 80 percent of infected boys experience painful urination, frequent urge to urinate, and white or yellow thick pus from the urethra. About half of infected girls have massive swelling of the vagina, abnormal green-yellow vaginal discharge, vaginal bleeding between periods, pelvic discomfort (itching and burning), and pain when urinating.

As the infection spreads—which is more common in girls than boys—there may be nausea and vomiting, fever, and rapid heartbeat or peritonitis. Inflammation of the tissues surrounding the liver also may occur, causing pain in the upper abdomen. Severe spread of the disease is also more common in girls and is characterized by signs of blood poisoning with tender lesions on the skin of the hands and feet and inflammation of the tendons of the wrists, knees, and ankles. If the disease spreads to the conjunctiva of the eyes, there may be scarring and blindness.

In both girls and boys, infection in the throat causes a mild, red sore throat.

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