Urinary symptoms usually appear within days or weeks of an infection. Low-grade fever, inflammation of the conjunctiva of the eye (conjunctivitis), and arthritis develop over the next several weeks. The arthritis may be mild or severe, and may affect only one side of the body or more than one joint.

Muscle and joint symptoms include:

• Achilles tendon pain
• Heel pain
• Joint pain in the large joints (hip pain, knee pain, and ankle pain are common)
• Low back pain

Eye and skin symptoms include:

• Eye discharge
• Eye pain - burning
• Eye redness
• Skin lesions on the palms and soles that may resemble psoriasis
• Small, painless ulcers in the mouth, tongue, and glans penis

Urinary and genital symptoms may include:

• Genital lesions (male)
• Incontinence
• Penis pain
• Skin redness or inflammation
• Urethral discharge
• Urinary hesitancy
• Urinary urgency
• Urination - burning or stinging

The diagnosis is based on symptoms. Since the symptoms may occur at different times, the diagnosis may be delayed. A physical examination may reveal conjunctivitis or typical skin lesions.

Tests that may be performed include:

• HLA-B27 antigen
• Joint x-rays
• Urinalysis