Typically, patients describe a similar story, lasting an average of 6.5 years that commenced with an acute UTI that responded partially to a short antibiotic course (3 days to 14 days). Most patients have been exposed to repeated courses of antibiotics, but these have ceased in the face of normal urinalyses, despite persisting symptoms. They continue to suffer low- grade lower urinary tract symptoms including bladder pain, with symptoms fluctuating and acute exacerbations several times a year. Urinalysis has usually been negative and the investigations, including urodynamics, cystoscopy, bladder biopsy, renal tract ultrasound, CT and MRI scans, have been unhelpful apart from the biopsies manifesting inflammation of the bladder mucosa.
 
Such patients have likely been diagnosed with Interstitial Cystitis or Bladder Pain Syndrome. They have failed to respond to cystodistension, urethral dilation, antimuscarinics, bladder instillations, Elmiron and various short-course and prophylactic low-dose antibiotic regimes. It is quite common for their symptoms to be attributed to psychological origins.