Jennifer T. Anger, MD, MPH

Jennifer T. Anger, MD, MPH

University of California San Diego

La Jolla, California

Jennifer T. Anger, MD, MPH, (she/her) Professor of Urology; Vice Chair of Research; and The C. Lowell and JoEllen Parsons Endowed Chair in Urology, Gender Affirming Surgery, Urologic Reconstruction, and FPMRS with the University of California at San Diego Health System is a board-certified female pelvic medicine and reconstructive surgery expert who has dedicated her career to improving the quality of surgical care for patients with pelvic floor disorders. She is the only physician in San Diego who performs gender affirming pelvic or "bottom" surgery, including vaginoplasty (penile inversion, peritoneal and intestinal), vulvoplasty (zero or shallow depth), metoidioplasty, phalloplasty, and robotic hysterectomy with vaginectomy and non-binary options.

Disclosures:

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

Posted by | 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

Posted by | 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

Posted by | 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

Posted by | 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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