May 17, 2020

What's going on with gonorrhoea?

sexually transmitted infection
5 min
Gonorrhoea is becoming untreatable
Gonorrhoea is one of the most common sexually transmitted infections (STIs) in the world, and the second most common in Europe. Much has been written i...

Gonorrhoea is one of the most common sexually transmitted infections (STIs) in the world, and the second most common in Europe. Much has been written in the press lately about its spread across the European continent and there are concerns that the STI is becoming untreatable and resistant to antibiotics. On the 6 June 2012, the World Health Organisation (WHO) declared that there is “urgent action needed to prevent the spread of untreatable gonorrhoea.”

That was after new figures revealed that cases of gonorrhoea have increased dramatically in Europe over the past few years. According to figures from the European Centre for Disease Prevention and Control’s (ECDC) recent surveillance programme on the infection, during 2010 there were more than 32,000 incidences of gonorrhoea.

But what has happened for it to get this far? The simple answer is: because people are having unsafe safe. The ECDC data from 2010 showed that gonorrhoea was reported three times more often in men than in women and the STI was most commonly found in young adults; 45 percent of all cases occur in the 15 to 24 age bracket.

This view was echoed by the Health Protection Agency (HPA) in May, when it was announced that in England alone cases of gonorrhoea increased by a quarter in 2011. Speaking at the time, Dr Gwenda Hughes, the head of STI surveillance at the HPA, said: “The 2011 data is a matter of concern regarding young heterosexuals and men who have sex with men. We anticipated some increase in diagnoses due to improvements in testing in recent years, but not on the scale seen here. This data shows that too many people are putting themselves at risk of STIs and serious health problems by having unsafe sex.”

So cases of gonorrhoea are increasing, but that is not the most concerning part. Within the 32,000 cases of gonorrhoea that were identified two year ago, nine percent were resistant to the antibiotics used to treat them, increasing from four percent the year before. The ECDC figures also revealed that antibiotic resistant cases were indentified in 17 European countries, whereas in 2009 this figure only stood at seven.

Commenting on the figures when they were released, Dr Marc Sprenger, the Director of the European Centre for Disease Prevention and Control, said: “This indicates the risk that gonorrhoea may become an untreatable disease in the near future.”

There are a number of antibiotics that gonorrhoea is now resistant to, including sulphonamides, penicillin, tetracyclines and quinolones. Current treatment advice in Europe stipulates the use of third-generation cephalosporins; ceftriaxone or cefixime. However, there have been a number of reports that certain strains of gonorrhoea are now becoming resistant to treatment methods.

“Millions of people with gonorrhoea may be at risk of running out of treatment options unless urgent action is taken,” the WHO said last month. “Already several countries, including Australia, France, Japan, Norway, Sweden and the United Kingdom are reporting cases of resistance to cephalosporin antibiotics – the last treatment option against gonorrhoea.”

Dr Manjula Lusti-Narasimhan, from the Department of Reproductive Health and Research at WHO, affirmed: “Gonorrhoea is becoming a major public health challenge, due to the high incidence of infections accompanied by dwindling treatment options. The available data only shows the tip of the iceberg. Without adequate surveillance we won’t know the extent of resistance and without research into new antimicrobial agents, there could soon be no effective treatment for patients.”

As a result, the World Health Organisation and the ECDC issued guidelines on how to tackle this ever-increasing threat in June. Both agree a gonorrhoea surveillance plan needs to be established, to assess how far and how quickly drug resistant strains of the infection are spreading.

The ECDC goes on to say that “close collaboration between clinicians, laboratories and local public health authorities is essential in order to ensure that cases with probable or confirmed treatment failure are appropriately investigated and treated.” It also believes that increasing awareness of the threat of antibiotic resistant gonorrhoea is vital, not only among the general public, but also in politicians, policy makers and healthcare providers.

Meanwhile, the WHO says that “greater vigilance on the correct use of antibiotics and more research into alternative treatment regimens for gonococcal infections” is the best way to manage the problem. It adds: “WHO’s Global Action Plan to control the spread and impact of antimicrobial resistance in Neisseria gonorrhoea also calls for increased monitoring and reporting of resistant strains as well as better prevention, diagnosis and control of gonococcal infections.”

Additionally, the HPA has its own ideas of what needs to be done, as Dr Hughes explains: “The rises in 2011 demonstrate it is crucial the work to reduce STIs continues. Improving awareness and encouraging safer sexual behaviour through health promotion and education is essential to helping prevent STIs. Coupled with this, ensuring easy access to sexual health services and STI screening is important for controlling the transmission of all STIs and needs to be focused on groups at highest risk.

“The importance of STI prevention and good sexual health becomes even clearer given emerging resistance to gonorrhoea treatment. Laboratory testing over the last five years has shown a large increase in the amount of resistance to the main drugs used to treat gonorrhoea, presenting the very real danger of untreatable gonorrhoea in the future.”

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Jun 13, 2021

How healthcare can safeguard itself against cyberthreats

Jonathan Miles
6 min
Jonathan Miles, Head of Strategic Intelligence and Security Research at Mimecast, tells us how the healthcare sector can protect itself from attacks

One of the most fundamental lessons from the COVID crisis is that health should always be a priority.  In a similar fashion to the human body that frequently fights off viruses and foreign invaders that intend to cause it harm, the sector itself is now a prime target for another type of external threat: cyberattacks.

The figures speak for themselves: between December and January this year, hospitals in the UK were at 89% capacity, with 7,000 fewer available beds than there usually are. As the pandemic increased pressure on hospitals, clinics, and research facilities to create a treatment for patients globally, it has left the sector exposed to hackers who, like a virus, have been targeting it relentlessly and evolving their tactics. 

From patient records being held ransom, to fake emails claiming to originate from the UN WHO, the NHS, or vaccine centres, through to attacks on the cold supply chain to find out the secret formula of the COVID vaccine, the healthcare industry is facing constant cyberattacks and struggling to cope. This threat is unlikely to go away anytime soon – and as such, the industry needs to take a proactive, preventative stance to stay safe in a dynamic digital world. 

Going digital 

The responsive nature of healthcare – particularly of hospitals – means that efficiency is crucial to the industry’s standard operations. To support this, the sector has been embracing technological advancements that can improve the quality of work, enabling staff to meet pressing deadlines, and enhancing patient care. For example, the industry has been digitising records and improving its ways of working through digital means over the past few years. 

This shift is critical to offer high quality patient care; yet, it also means the sector has become more dependent on IT, which can come with a risk if cybersecurity processes employed are deemed as inadequate. 

Without the correct security measures in place, the desired efficiency gains realised, can be easily lost in a heartbeat. Simply put, an elementary glitch in the system can have a tremendous ripple effect on many areas, from accessing patient records and conducting scans, to maintaining physical security and protecting the intellectual property of experimental treatment development.

To prevent this, healthcare organisations need to ensure they’re considering cybersecurity as part of their overall digital transformation strategy – and setting the right foundations to create a culture where safety goes hand in hand with patient care. 

Strengthening defences

Before implementing cybersecurity process, healthcare organisations need to assess the potential risks they face. Depending on how much confidential data the trust has, where it is stored, who has access to it and via which means, the cybersecurity strategy and associated solutions will change. 

It’s fair to say that a medical device start-up where all employees have a corporate-sanctioned laptop and access data via a VPN will have radically different needs to a large hospital with hundreds of frontline workers connecting to the hospital’s Wi-Fi using their personal device. 

These requirements will pale by comparison to a global pharmaceutical giant with offices in multiple locations, a large R&D department researching new treatments for complex diseases and a fully integrated supply chain. Considering the existing setup and what the organisations is looking to achieve with its digital transformation strategy will therefore have an immediate impact on the cybersecurity strategy.

Despite this, there are fundamentals that any organisation should implement: 
Review and test your back-up policy to ensure it is thorough and sufficient – By checking that the organisation’s back-up is running smoothly, IT teams can limit any risks of disruption in the midst of an incident and of losing data permanently.

In our recent State of Email Security report, we found that six out of ten organisations have been victims of ransomware in 2020. As a result, afflicted organisations have lost an average of six days to downtime. One third of organisations even admitted that they failed to get their data back, despite paying the ransom. In the healthcare industry, this could mean losing valuable patient records or data related to new treatments – two areas the sector cannot afford to be cavalier about.

Conduct due diligence across the organisation’s supply chain – Healthcare organisations should review their ways of working with partners, providers and regulatory institutions they work with in order to prevent any weak link in their cybersecurity chain. Without this due diligence, organisations leave themselves exposed to the risks of third party-led incidents. 

Roll out mandatory cybersecurity awareness training - Healthcare organisations shouldn’t neglect the training and awareness of their entire staff – including frontline workers who may not access the corporate network on a regular basis. According to our State of Email Security report, only one fifth of organisations carry out ongoing cyber awareness training.

This suggests it is not widely considered as a fundamental part of most organisations cyber-resilience strategy, despite the fact many employees rely on their organisation’s corporate network to work. By providing systematic training, healthcare organisations can help workers at all levels better understand the current cyberthreats they face, how they could impact their organisation, the role they play in defending the networks, and develop consistent, good cybersecurity hygiene habits to limit the risks of incidents. 
Consider a degree of separation – Information and Operational Technology (IT and OT) networks should be separated.

Although mutually supported and reliance on each other, employees shouldn’t be accessing one via the other. This should be complemented by a considered tried and tested contingency and resiliency plan that allows crucial services to function unabated should there be a compromise. Similarly, admin terminals should not have internet access to afford a degree of hardening and protection for these critical accounts.

As the sector becomes a common target for fraudulent and malicious activity, putting cybersecurity at the core of the organisation’s operations is critical. It will help limit the risks of disruption due to cyberattacks, reduce time spent by the cybersecurity team to resolve easily avoidable errors, and ensure that institutions can deliver patient care, safe in the knowledge that their networks are safe.  

Fighting future threats

With technology continuing to change the face of healthcare, the surface area and vectors available for attacks by malicious actors is constantly increasing. With the introduction of apps, networked monitoring devices, and a need for communication, the attack vector is ever expanding, a trend that needs to be monitored and secured against.

To prevent any damage to patients, staff, or the organisation they are responsible for, healthcare leaders must put security front and centre of their digital transformation strategy. Only then can the sector harness the full benefits of technology. Doing this should include implementing cybersecurity awareness training to challenge misconceptions around security, encourage conversation, and to ensure employee knowledge of the security basics and threats faced. 

This ultimately allows healthcare organisations to do what they do best: provide the highest standard of patient care, safe in the knowledge that their operations, patients, and data are safe.

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