Background: There has been a resurgence of tuberculosis (TB) in the United States, largely because of the HIV epidemic. The impact of this epidemic on the incidence and clinical presentation of genitourinary TB is largely unknown. We describe the clinical findings and outcomes of genitourinary TB in patients infected with HIV and compare them with those in patients not infected with HIV. Methods: We retrospectively studied the case records of 16 patients infected with HIV and genitourinary TB and compared them with those of 8 patients without HIV infection diagnosed with genitourinary TB between January 1, 1991, and December 31, 1997, at a large, urban, inner-city, tertiary hospital. Data abstracted from records include demographics, symptoms, signs, laboratory and radiologic findings, and in-hospital mortality. Results: Of 1282 patients with tuberculosis, 24 patients had positive urine cultures for Mycobacterium tuberculosis. HIV infection was present in 16 patients (75%). Patients infected with HIV were younger (mean age, 39.1 ± 6.2 versus 53.9 ± 17.2, P = 0.047) but did not differ significantly in clinical presentation from patients who did not have HIV infection. The combined mortality rate was 16.7%. Advanced age was the strongest predictor of poor outcome (P = 0.03). Conclusions: HIV infection was present in 66.7% of patients with genitourinary TB seen an inner-city hospital. Increasing age was associated with poor survival. No significant differences in clinical presentation nor in-hospital mortality were observed between those with HIV infection and those without HIV infection.