Helicobacter pylori (H. pylori) has been associated with the pathogenesis of chronic active gastritis, peptic ulcer disease1 and gastric carcinoma.2 Understanding the exact mode of transmission of H. pylori is essential in order to limit its spread and serious diseases associated with it. Living on human and ectopic gastric mucosa, the organism has not been convincingly isolated from other animals. Most infections are acquired in childhood and some of the risk factors associated with childhood infection include poor sanitation, overcrowding and lower socioeconomic status.
The theory of direct person-to-person spread is now generally accepted, but the route of transmission remains open to conjecture. No predominant route of transmission has been defined and the possibilities include faecal-oral, oro-oral and gastro-oral. Helicobacter pylori has been identified in saliva and in swabs taken from the oral cavity through molecular techniques. It remains unclear whether the bacteria detected represented colonisation of the oral cavity or transient regurgitation of the micro-organisms from the stomach into the mouth during the process of gastro-oesophageal reflux. Gastrooral or oro-oral routes could be important in the transmission of the infection from mothers to children and between siblings.
It is unlikely that H. pylori could be transmitted between spouses. Most married couples demonstrate little concordance of bacterial strain as typed by molecular techniques and treated patients are seldom re-infected by their untreated infected spouses.
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