If H. pylori (Helicobacter pylori) can be transmitted through close contact, why did my long-term partner test negative after I tested positive?

H. pylori Transmission and Negative Test Results in Partners

H. pylori infection in one partner with a negative test in a long-term spouse is common and does not necessarily indicate recent acquisition of the infection. 1, 2

Understanding H. pylori Transmission

• H. pylori is primarily transmitted through person-to-person contact via oral-oral (through vomitus or saliva) or fecal-oral routes, but transmission efficiency between adults is relatively low compared to childhood acquisition 2
• Most H. pylori infections are acquired during childhood, often before age 10, and can persist for decades without symptoms 1, 2
• The prevalence of H. pylori varies widely by geographic area, age, race, ethnicity, and socioeconomic status, with higher rates in developing countries 2
• Family clustering of H. pylori is common, but this primarily reflects shared environmental exposure during childhood rather than adult-to-adult transmission 1, 3

Why Your Partner May Test Negative

• Despite close contact through kissing and sharing meals, transmission between adult partners is relatively inefficient 2
• Individual differences in susceptibility to H. pylori colonization exist due to:
  • Variations in gastric acid production (higher acid can prevent colonization) 1
  • Differences in immune response to the bacteria 4
  • Previous antibiotic exposure that may have inadvertently eradicated H. pylori 1
• False negative results in your partner could occur if:
  • They recently used antibiotics or proton pump inhibitors (PPIs) before testing 5, 1
  • The test used had limited sensitivity (particularly with rapid in-office tests or non-validated serological tests) 5, 1

Testing Considerations

• The most accurate non-invasive tests for H. pylori are the urea breath test (UBT) and laboratory-based stool antigen tests using monoclonal antibodies 1, 3
• Serological tests cannot distinguish between active infection and past exposure, as antibodies persist in blood long after infection clearance 5, 1
• For accurate testing, proton pump inhibitors should be stopped for at least 2 weeks and antibiotics for at least 4 weeks before testing 5, 1

Clinical Implications

• Your positive H. pylori test likely represents a long-standing infection acquired in childhood rather than a recent event 2, 6
• The risk of developing complications from H. pylori (such as ulcers or gastric cancer) depends on multiple factors including bacterial strain virulence, host genetics, and environmental factors 4
• Treatment is recommended for all individuals with confirmed H. pylori infection, regardless of symptoms or duration of infection 1, 7

Key Takeaway

• The discordant H. pylori status between you and your partner is common and expected, even in long-term relationships 1, 2
• Your positive test most likely represents a childhood-acquired infection that has persisted asymptomatically for many years rather than recent acquisition 2
• If concerned about your partner's status, consider retesting with a urea breath test or stool antigen test after ensuring they haven't used PPIs for at least 2 weeks or antibiotics for 4 weeks 5, 1