 New
ways of looking at old diseases
August
2007
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.
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.”
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- Click on photo for high resolution
version
- Photo credit: SDP Photo, Sam
D'Agostino
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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.
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