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Dysuria, defined as bothersome and persistent symptoms of urinary frequency, urgency, or incontinence, is common among HIV-infected persons and is associated with a decreased quality of life and increased morbidity and mortality (1202,1203). Older age, female gender, poverty, sexual orientation, and history of drug use increase the risk of HIV-associated dysuria (1123). Determining the cause of dysuria and the severity of associated renal dysfunction is difficult in clinical practice. Because the test characteristics of routine urine testing for urinary tract infection are poor, the laboratory diagnosis of asymptomatic dysuria is challenging. Collecting a complete urine sample for urinalysis and culture testing is often impractical in clinical practice. Urine dipstick tests for proteins (e.g., glucose) and nitrites have low sensitivity and specificity for urinary tract infection (1210). Urinary white blood cell count is a good marker of urinary tract infection in patients with dysuria, but is nonspecific (1213). Other tests, such as antimicrobial susceptibility testing, uropontin typing, and nucleic acid testing, are not available widely, are labor intensive, are costly, and do not accurately reflect bacterial burden. Screening HIV-infected patients for asymptomatic infection with HSV and for cervical HPV can identify female sex partners and individuals who are at risk of developing genital herpes, which can lead to a range of adverse effects. Laboratory testing can be performed more efficiently with assays for HSV detection than with testing for HPV, although the detection of oncogenic HPV is usually preferred when possible (1217). An exploratory study showed that the presence of genital herpes detected using the HerpES assay (ESRON Diagnostics) was associated with women being HSV DNA positive, although the study was not designed to assess diagnostic accuracy (1218). A multicenter trial showed that the HerpES assay was accurate for detecting genital herpes (positive predictive value 0.97, negative predictive value 0.81) (1219).
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