The patient (usually female) complains of urinary frequency and urgency, internal dysuria, and suprapubic pain or discomfort. The onset of symptoms is generally abrupt, often causing her to seek care within 24 hours. There may have been some antecedent trauma (sexual intercourse) to inoculate the bladder, and there may be blood in the urine (hemorrhagic cystitis). Usually, there is no labial irritation, external dysuria, or vaginal discharge (which would suggest vaginitis or cervicitis), and no fever, chills, nausea, flank pain, or costovertebral angle tenderness (which would suggest an upper urinary tract infection [UTI] or pyelonephritis).