New ways of looking at old diseases: An African sojourn confirms a vocation in sexual health

When Catriona Bradshaw volunteered as a visiting medical officer in sexual health and HIV medicine at an African hospital, it was a turning point that confirmed her career choice – in sexual health.

Catriona Bradshaw, Photo credit: SDP Photo, Sam D'Agostino
Catriona Bradshaw, Photo credit: SDP Photo, Sam D’Agostino

Now, with the help of her L’ORÉAL Australia For Women In Science Fellowship, Bradshaw plans to clear up confusion about a common genital infection of women – bacterial vaginosis.

She suspects that bacterial vaginosis may be sexually transmitted. By studying the spread of the disease in young women she plans to determine if this is the case.

She hopes that her work will lead to improved treatment regimes – benefiting women in the West and in developing countries.

Catriona Bradshaw’s interest in sexual health was triggered when she was a young medical registrar with an interest in infectious diseases, in particular sexually transmitted diseases (STDs).

But although specialist study in the field was available through the Australian College of Sexual Health Physicians, its relative obscurity as a medical specialty made her question whether it was a good choice, until an opportunity to work in Africa came her way.

So Bradshaw, whose partner was working in Malawi on malaria research, went to work at the Queen Elizabeth Central Hospital in the Central African country’s largest city Blantyre for six months, despite criticism from colleagues and teachers about taking time off at that point in her medical career.

She says that when she arrived at the hospital Malawi was in the grip of an HIV epidemic driven by STDs. But the only person she could find among the staff who actually knew where the STD clinic was located, was a cleaner. When she eventually found the clinic, she was greeted by a line of people snaking away from the door—and her next six months’ work was cut out for her.

“I had a manual on sexually transmitted diseases and a pair of incredible Malawian sexual health nurses,” Bradshaw says of the experience, which covered the gamut of STDs from gonorrhoea to HIV.

When Bradshaw returned to Australia, she enrolled in the College’s program to start her sexual health training. This eventually led her to complete a PhD at The University of Melbourne’s School of Population Health on the epidemiology of two genital infections: bacterial vaginosis (BV) in women; and non-gonococcal urethritis in men.

Her current post-doctoral work at Monash University’s Department of Epidemiology and Preventive Medicine extends this work – looking at the causes of bacterial vaginosis, and how it spreads.

“It’s a perfect blend of interesting clinical medicine, infectious diseases and public health, and an opportunity to really make a difference at a population and a community level,” Bradshaw says of her chosen field of study.

According to Bradshaw, BV is one of the most common genital diseases, affecting at least 10% of women in Australia and other western countries, and far higher numbers in developing countries. It is associated with miscarriage, prematurity, low-birth weight, and increases the risk of acquiring HIV infection and sexually transmitted infections.

The disease is commonly perceived by women and their doctors to be due to an imbalance in the normal vaginal flora, but Bradshaw’s studies have shown a pattern more akin to sexually transmitted diseases like chlamydia, with risk factors including multiple sexual partners, new partners, and sex work.

Bradshaw is now planning a number of studies to further investigate BV. Initially she plans a study with first-year university students to look at the prevalence of the disease in young women and to examine its association with specific sexual practices.

This will be followed by a cohort study drawing from the same pool of subjects, which will look at the incidence of BV and other genital infections over a two-year period and their association with sexual practices. Other projects will look at BV in lesbian women.

She is also commencing a trial of new treatment options for this infection.

“Understanding the contribution of sexual transmission to BV is essential to improving current treatments and preventing the complications of BV experienced by women and their children,” she says. Bradshaw balances her research into BV with her clinical work as a sexual health physician at the Melbourne Sexual Health Clinic.

“I feel lucky to be able to combine my research with seeing and treating patients,” she says. “I can see my research turning into clinical benefits for my patients.”

Biographical details

2007 – Commenced postdoctoral studies Monash University Department of Epidemiology and Preventive Medicine Sexual health physician, Melbourne Sexual Health Centre honorary Fellow School of Population Health, The University of Melbourne

2006 – PhD The University of Melbourne School of Population Health

2003 – Admitted as a Fellow of The Australasian Chapter of Sexual Health Physicians, Royal Australian College of Physicians

1999 – Diploma of Venereology Melbourne Sexual Health Centre

1998 – Certificate in Sexual and Reproductive Health Family Panning Victoria

1992 – Bachelor of Medicine, Bachelor of Surgery, First Class honours Monash University

Career Highlights

2007 – NHMRC Public Health Fellowship

2003-2006 – NHMRC Public Health Postgraduate Research Scholarship (PhD)

2003 – HR Ackerman Travelling Scholarship, The University of Melbourne, Australia

1999 – Venereology Society of Victoria Prize, Diploma of Venereology

Research Highlights

Recipient (with others) of NHMRC public health research project grant, $255,425 for the treatment of bacterial vaginosis: a randomised controlled trial.

Major research projects undertaken:

–        A cross sectional study of 350 women to examine the epidemiological associations of BV

–        A prospective study of 130 women with BV to evaluate the efficacy of current recommended therapy

–        A case control study of non-gonococcal urethritis to examine possible causative agents and epidemiological and clinical associations in 636 men

–        A cross-sectional study of street-based injecting drug users to determine the prevalence of blood-borne viruses and sexually transmitted infections.

–        A randomized controlled trial to determine the efficacy of combination antibiotic therapy in the treatment of BV (NHMRC project grant) – in progress (n=450)

–        Visiting Medical Officer (volunteer) in sexual health and HIV medicine at the Queen Elizabeth Central hospital, Blantyre.

–        Six months in Kenya at the start of PhD (2002) developing a research protocol to examine access and provision of antiretroviral therapy to Kenyan sex workers, and genital tract shedding of HIV-1.

–        20 journal articles including 9 first author; 1 book chapter.