Jennifer T. Anger, MD, MPH

Jennifer T. Anger, MD, MPH

University of California San Diego

San Diego, California

Jennifer T. Anger, MD, MPH, (she/her) is Professor of Urology at the University of California, San Diego, and serves as the Vice Chair of Research in UC San Diego’s Urology Department. Dr. Anger is also a surgeon at UC San Diego, board-certified in Female Pelvic Medicine and Reconstructive Surgery. Dr. Anger specializes in gender-affirming surgery for transgender and non-binary patients, including vaginoplasty, vulvoplasty, metoidioplasty, phalloplasty, and robotic hysterectomy with vaginectomy and non-binary options. Dr. Anger previously served as an assistant professor of urology at the University of California, Los Angeles, gaining expertise in robotic-assisted pelvic floor reconstruction. Following that, she joined Cedars-Sinai Medical Center, building their residency program in urology and founding and directing the ACGME-accredited Cedars-Sinai fellowship in female pelvic medicine and reconstructive surgery.

Dr. Anger completed a dual-fellowship, first in urologic reconstruction with Dr. George Webster at Duke Medical Center in Durham, North Carolina. She went on to complete her second fellowship in urological health services research under the mentorship of Dr. Mark Litwin at the University of California, Los Angeles, where she also earned a master’s degree in public health. She completed her residency training in surgery and urology at New York-Presbyterian Weill Cornell Medical Center, New York. Dr. Anger received her medical degree from the University of Southern California Keck School of Medicine in Los Angeles.

Dr. Anger received a career development award from the National Institutes of Health to develop and test quality of care measures for women with urinary incontinence, and her clinical research has additionally been funded by the Agency for Healthcare Research and Quality, the Centers for Disease Control and Prevention, and the Urology Care Foundation. She has published over 200 peer-reviewed manuscripts. Her research interests are focused on improving the quality of care for transgender individuals and for women with incontinence, improving surgical and medical outcomes for transgender adolescents and adults, and reducing disparities in care for underserved populations. She is a member of the World Professional Association for Transgender Health, the American Urological Association, the Society for Urodynamics, Female Pelvic Medicine and Urogenital Reconstruction, the American Urogynecologic Society, and the Genitourinary Reconstructions Society.

Talks by Jennifer T. Anger, MD, MPH

Point-Counterpoint: PCR and NGS is the New Standard for Clinical Evaluation, not Culture and Sensitivity – Pro

Point-Counterpoint: PCR and NGS is the New Standard for Clinical Evaluation, not Culture and Sensitivity – Pro

| Nov 2023

Jennifer T. Anger, MD, MPH, makes the case that polymerase chain reaction (PCR) and next-generation sequencing (NGS) is the new standard for clinical evaluation of urinary tract infections (UTIs) in this Point-Counterpoint lecture. Dr. Anger explains that UTIs are caused by a dysbiosis of normal flora and asserts that culture doesn’t provide a complete picture and doesn’t help symptomatic patients on antibiotics who are culture-negative; she asserts NGS fills in the diagnostic gaps.

Dr. Anger addresses the utility of NGS in catheter-associated UTIS (CAUTIs), which make up ~80 percent of all UTIs. Dr. Anger presents data from a head-to-head comparative phase II study of standard urine culture and sensitivity versus DNA NGS testing for UTIs that showed 30 percent of DNA-positive samples were culture-positive; additionally, patients who were culture-negative and NGS-positive had improved outcomes when treatment was initiated based on NGS results. She addresses cost before turning to NGS studies at UCSD on interstitial cystitis (IC), fertility, stricture disease, and inflatable penile prosthesis (IPP) infections and using NGS to tailor antibiotics.

Dr. Anger concludes with four points: NGS offers a comprehensive scope of the urinary tract microbiome; has superior diagnostic ability compared with culture; informs improved tailoring of antibiotics; and has the potential to provide insights for certain conditions including stone disease, infertility, and IC.

This lecture is part of a Point-Counterpoint debate. Its opposing lecture is “Point-Counterpoint: PCR and NGS is the New Standard for Clinical Evaluation, not Culture and Sensitivity – Con.”

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Assessment of the Urinary Microbiome

Assessment of the Urinary Microbiome

| Oct 2023

Jennifer T. Anger, MD, MPH, discusses microbiome assessments and the ongoing debate between cultures and next generation sequencing. She highlights the connection between acute symptoms and the potential presence of undetectable microorganisms in traditional culture methods, which underscores the need for more advanced technologies.

Dr. Anger introduces PCR and next generation sequencing as promising alternatives to culture-only assessments, offering higher sensitivity and comprehensive evaluation of the urinary microbiome. By utilizing these methods, a wider range of bacterial and fungal DNA can be detected, providing a more thorough understanding of the microbial composition.

Dr. Anger then addresses concerns of over-treatment and the implications of identifying microbial DNA without certainty of viability or pathogenicity. By understanding patients’ microbial composition comprehensively, there is potential for improved diagnosis and targeted treatment options for various diseases and conditions.

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Recurrent UTIs in Women: Ask the Guideline

Recurrent UTIs in Women: Ask the Guideline

| Jun 2023

Jennifer Anger, MD, MPH, discusses American Urological Association (AUA) guidelines regarding recurrent urinary tract infections (rUTIS) in women. She begins by discussing antimicrobial stewardship and the consideration of collateral damage, explaining antimicrobial resistance among uropathogens has increased dramatically in the past 20 years.

Dr. Anger characterizes the index patient for the 2019 rUTI guideline as an otherwise healthy adult female with an uncomplicated, culture-proven rUTI associated with acute-onset symptoms. She summarizes guideline highlights, including the recommendation that clinicians obtain a complete patient history and perform a pelvic examination in women presenting with rUTIs. Additionally, clinicians should obtain urinalysis, urine culture, and sensitivity with each symptomatic acute cystitis episode prior to initiating treatment for rUTIs.

Dr. Anger outlines first-line therapy (nitrofurantoin, TMP-SMX, and fosfomycin) and explains clinicians should use as short a duration of antibiotics as reasonable for rUTI patients with an acute cystitis episode. For patients with urine cultures resistant to oral antibiotics, clinicians may treat with culture-directed parenteral antibiotics for as short a course as reasonable.

Dr. Anger discusses use, dosing, and duration of prophylactic antibiotics and points out that clinicians may offer cranberry prophylaxis for rUTIs, but explains that studies are lacking in this area. Clinicians should repeat urine culture to guide further management when UTI symptoms persist following antimicrobial therapy.

In peri- and post-menopausal women with rUTIs, clinicians should consider vaginal estrogen therapy to reduce the risk of recurrence. Dr. Anger then highlights the 2022 UTI Guideline Update and explains randomized, controlled trials that contributed evidence to this amendment report.

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Recurrent Uncomplicated Urinary Tract Infections in Women: AUA/CUA/SUFU Guideline 2019

Recurrent Uncomplicated Urinary Tract Infections in Women: AUA/CUA/SUFU Guideline 2019

| May 2020

Jennifer T. Anger, MD, MPH, Associate Professor of Urology at Cedars-Sinai Medical Center, discusses recurrent uncomplicated urinary tract infections (UTIs) in women. Dr. Anger chairs the AUA committee on guidelines for infections, and she discusses the rationale behind recent changes to recommendations. She outlines how the thinking about recurrent infections has changed over time, and highlights the collateral damage that a one-size-fits-all antibiotic treatment can cause, noting that the new guidelines emphasize treating individual urinary cultures. She goes on to discuss patient profiles, common symptoms, and what the guidelines recommend for initial work-ups as well as treatments. Dr. Anger further delves into ways to prevent or decrease the risk of UTIs with antibiotic prophylaxis, along with the possible risks of doing so.

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