Do I need to test my entire household for Helicobacter pylori (H. Pylori) if one family member is infected?

Testing Family Members for H. Pylori

Yes, you should test family members residing in the same household when H. pylori infection is documented in one family member, as person-to-person transmission occurs within families and testing can protect them from infection, reinfection, and H. pylori-related diseases including gastric cancer. 1

Rationale for Household Testing

The 2022 Taipei Global Consensus strongly recommends testing family members residing in the same household of patients with proven active H. pylori infections (91% agreement, moderate evidence level). 1 This recommendation is based on several key factors:

• Person-to-person transmission occurs within families, making household members at significantly increased risk 1
• First-degree relatives have a 2-3 times increased risk of H. pylori infection, and this risk increases 10-fold when multiple family members are affected 2
• Testing and treating infected family members can break the transmission cycle and prevent reinfection of the index patient 2

Priority Groups Within the Family

Not all family members carry equal risk. Prioritize testing based on these factors: 2

• First-degree relatives of patients with gastric cancer (parents, siblings, children) should receive highest priority, as they have 2-3 times increased gastric cancer risk 2
• First-degree relatives when multiple family members have gastric cancer face a dramatically elevated 10-fold increased risk 2
• All household members should be considered when the index patient experiences recurrent infection after treatment, as ongoing intrafamilial exposure is likely 2

Clinical Benefits of Family Testing

Testing and treating all infected household members provides multiple benefits: 1

• Protects family members from developing H. pylori-related diseases including peptic ulcer (17% lifetime risk among infected individuals) and gastric cancer 1
• Prevents reinfection of the successfully treated index patient by eliminating household reservoirs 2
• Engages those who test positive to comply with eradication treatment when approached as part of family screening 1
• Prevents progression to atrophic gastritis and preneoplastic conditions when caught early 3

Testing Methodology

Use noninvasive testing methods for family screening: 1

• Urea breath test (UBT) or stool antigen test are the preferred noninvasive tests for active infection 1
• Avoid serology (IgG antibody testing) as it remains positive long after eradication and cannot distinguish active from past infection 1
• Ensure patients are off antibiotics, bismuth, or proton pump inhibitors for at least 2 weeks before testing to avoid false negatives 1

Common Pitfalls to Avoid

• Do not rely on serology alone for family screening, as it creates a "serologic scar" and cannot confirm active infection 1
• Do not test only symptomatic family members—asymptomatic carriers can transmit infection and develop complications 2
• Do not delay testing first-degree relatives of gastric cancer patients—they warrant testing even without symptoms due to substantially elevated cancer risk 2
• Do not treat the index patient alone and ignore household members—this creates a cycle of reinfection 2

Treatment Approach

When family members test positive, treat all infected household members concurrently to break the transmission cycle 2. Treatment typically consists of a proton pump inhibitor combined with antibiotics, though local antibiotic resistance patterns should guide specific regimen selection 4.