Clinical signs of dourine are highly variable in manifestation and severity. The disease is characterised mainly by swelling of the genitalia, cutaneous plaques and neurological signs but severity varies with the virulence of the strain, the nutritional status of the horse and stress factors. Clinical signs often develop over weeks or months, frequently waxing and waning with relapses, probably precipitated by stress. This can occur several times before the animal either dies or experiences an apparent recovery. The mortality rate is believed to be in excess of 50%.
Genital oedema and reproductive tract mucopurulent discharges are often the first signs. Mares develop a mucopurulent vaginal discharge, and the vulva becomes oedematous; this swelling may be marked leading to vaginal prolapse and may extend along the perineum to the ventral abdomen and mammary gland and may result in depigmentation, similar to that seen in coital exanthema with EHV-3 infection. Abortion can occur with more virulent strains. Stallions develop oedema of the prepuce and glans penis with paraphimosis in some cases, and can develop a mucopurulent urethral discharge. The swelling may spread to the scrotum, perineum, ventral abdomen and thorax and the affected skin may become depigmented.
Characteristic raised oedematous patches 2-10 cm in diameter (sometimes called ‘silver dollar plaques’) may appear on the skin on the neck, hips, lower parts of the abdomen and particularly over the ribs. These cutaneous plaques usually last for 3 to 7 days and are pathognomonic for the disease, although they do not occur with all infecting strains. Neurological signs can develop with signs of progressive weakness, incoordination and, eventually, paralysis. Facial paralysis, which is generally unilateral, may be seen in some cases. Conjunctivitis and keratitis are common, and in some outbreaks, ocular disease may be the first sign of dourine and anaemia and intermittent fever may also be found. Dourine also results in a progressive loss of condition and affected animals may become emaciated, although their appetite remains good.