This audit assessed adherence to standards specified in the BASHH national guidance for management of infection with Neisseria gonorrhoeae (2018). All UK GUM/Integrated Sexual Health Services (Level 3 STI services) were invited to complete a brief survey of clinic service arrangements and case note review of the 40 individuals per clinic diagnosed with gonorrhoea via microscopy, nucleic acid amplification test (NAAT) and/or culture up to the end of 2019. Data collection was between 30/01/2020 and 27/03/2020 using an online survey. There was no case of possible treatment failure with ceftriaxone having been reported to PHE. The standard for receiving first line treatment was narrowly missed. The other five national audit standards were not met. Based on the results, the following recommendations were made: individual sexual health service to identify areas for improvement in performance or documentation for key outcomes; adhere carefully to treatment guidelines; encourage all individuals with gonorrhoea to accept testing for syphilis, HIV as well as chlamydia, and to engage in partner notification.

exocytosis; cytokine production and cellular response to cytokine stimulus. DSP analysis provided additional spatial transcriptomic data, highlighting differential inflammatory signature expression between the tumour and tumour capsule. Conclusion Our results demonstrate that the phenotype of tumour endothelium contributes to pathways which promote immune privilege in HCC. Spatial transcriptomics can provide further insight of how endothelial profiling correlates with immune cell infiltration in HCC. We have identified several new genes which need further validation but could be novel therapeutic targets that reprogramme the tumour endothelium and boost the efficacy of current immunotherapies.

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Background Numerous studies have shown the effectiveness of testing for hepatitis B (HBV) and hepatitis C (HCV) in emergency departments (ED), due to the elevated prevalence amongst attendees. The aim of this study was to conduct a cost-effectiveness analysis of universal opt-out HBV and HCV testing in EDs based on two long-term studies of the real-world effectiveness of testing in two large ED’s in the UK. MethodsA Markov model was used to evaluate ED-based HBV and HCV testing versus no ED testing, in addition to current testing practice. The two EDs had a HBV HBsAg prevalence of 0.5%-0.9% and an HCV RNA prevalence of 0.9%-1.0%. The analysis was performed from a UK health service perspective, over a lifetime time horizon. Costs are reported in British pounds (GBP), and outcomes as quality adjusted life years (QALYs), with both discounted at 3.5% per year. Incremental cost-effectiveness ratios (ICER) are calculated as costs per QALY gained. A willingness-to-pay threshold of £20,000/QALY was used. The cost-effectiveness was estimated for both infections, in both ED’s. Results HBV and HCV testing were highly cost-effective in both settings, with ICERs ranging from £7,177 to £12,387 per QALY gained. In probabilistic analyses, HBV testing was 89% to 94% likely to be cost-effective at the threshold, while HCV testing was 94% to 100% likely to be cost-effective, across both settings. In deterministic sensitivity analyses, testing remained cost-effective in both locations at ≥0.25% HBsAg prevalence, and ≥0.49% HCV RNA prevalence. This is much lower than the prevalence observed in the two EDs included in this study.Conclusions HBV and HCV testing in urban EDs is highly cost-effective in the UK, and can be cost-effective at relatively low prevalence. These results should be reflected in UK and European hepatitis testing guidelines.