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Background  The prevalence of  Helicobacter pylori  including strains with putatively virulent genotypes is high, whereas the  H. pylori -associated disease burden is low, in Africa compared to developed countries. In this study, we investigated the prevalence of virulence-related  H. pylori  genotypes and their association with gastroduodenal diseases in The Gambia.    Methods and Findings  DNA extracted from biopsies and  H. pylori  cultures from 169 subjects with abdominal pain, dyspepsia or other gastroduodenal diseases were tested by PCR for  H. pylori . The  H. pylori  positive samples were further tested for the  cagA  oncogene and  vacA  toxin gene.  One hundred and twenty one subjects (71.6%) were  H. pylori  positive. The  cagA  gene and more toxigenic  s1  and  m1  alleles of the  vacA  gene were found in 61.2%, 76.9% and 45.5% respectively of Gambian patients harbouring  H. pylori . There was a high prevalence of  cagA  positive strains in patients with overt gastric diseases than those with non-ulcerative dyspepsia (NUD) (p = 0.05); however, mixed infection by  cagA  positive and  cagA  negative strains was more common in patients with NUD compared to patients with gastric disease (24.5% versus 0%; p = 0.002).    Conclusion  This study shows that the prevalence of  H. pylor i is high in dyspeptic patients in The Gambia and that many strains are of the putatively more virulent  cagA + , vacAs1  and  vacAm1  genotypes. This study has also shown significantly lower disease burden in Gambians infected with a mixture of  cag -positive and  cag -negative strains, relative to those containing only  cag -positive or only  cag -negative strains, which suggests that harbouring both  cag -positive and  cag -negative strains is protective.

Mixed Infection with cagA Positive and cagA Negative Strains of Helicobacter pylori Lowers Disease Burden in The Gambia