H Pylori Transmission By Urine, can Barjammar please review?

[Health Inquirer]

Hello,

First, I want to thank Dr. Marshall and everyone on this site for offering this service. All of the work that goes into this site in very generous and kind. It is really heart warming to see everyone helping each other out. Thank you very much.

I have a strange question. I was hoping Barjammar could review it. I by no means mean any offense to any other person. I guess it is just sometimes more reassuring to hear from someone with an in depth medical background. Please do not be offended, I hope you understand. However, if you also happen to have some knowledge on this particular matter, I am certainly interested in hearing about what you know and if you are aware of any studies to back up any information that will be deeply appreciated as well. It seems like some of you work in labs specifically with H Pylori, do you know anything about this?

My friend and I were camping and were unable to wash our hands. I didn’t know I had this H Pylori infection at the time, but found out soon after. Anyhow, I went to the bathroom, urinated and then wiped. It’s possible that some urine may have seeped through the toilet paper onto my hands. Worst case scenario, let’s say it did. Also, I had to throw the toilet paper out, so maybe I accidentally touched the part of the toilet paper that touched my skin. Immediately after going to the bathroom I gave him a massage. I massaged his hands. He may have touched his mouth after that. Also he may have touched other parts of him I massaged with his hands and then put his hands to his mouth or on food. Is it possible if he touched his mouth after I massaged his hands right after going to the bathroom that I gave him H pylori this way? Also, what if he ate some finger foods like chips after I massaged his hands after I just went to the bathroom, could he have gotten it that way? Normally, this wouldn’t be an issue, but we were camping. There are many times when I am hiking and camping and don't have the ability to wash hands, so it would be nice in general to know whether or not H Pylori is transmitted via urine (I get cracked skin and my arms push out pus from hand sanitizer & antibacterial soaps, so I can't use them). Even if I did not have these scenarios, it would be nice to know as a member of this world community if urine is a route of transmission for H Pylori. It seems that since we know it is transferred fecal to oral we would know about urine to oral, but it also seems to be unknown or it is not spoken about.

Thank you for your time into this matter and again thank you for providing this service.
My deepest gratitude to you all.

[Helico_scientist]

Hello,

I work in Dr Marshall's lab as a research assistant. First you have to know that your skin and mouth are full of different bacteria, most of them are harmless. However, urine is nearly sterile. If somehow, H pylori end up on your hands (mainly from stool or vomit... not urine) it would not survive long enough to contaminate your partner, this is not an environment where Hpylori likes to grows, too many other bacteria, too dry... You don't have to worry about this. I am pretty sure you did not contaminate your partner by giving him a massage with "dirty hands". You could ask him to do a breath test to know if he has the bacteria but if he is positive, it is very likely he got infected during his childhood.

[Health Inquirer]

Hello Helico Scientist,

Thank you very much for taking the time to reply and for sharing your professional expertise. I deeply appreciate it. It is very thoughtful and helpful of you.

I have a few follow up questions. So, if I am understanding you correctly, even if it would have been stool or vomit that got on my hands and then I massaged him immediately after and he touched his mouth or touched food and then ate it, you do not think he would have even gotten it that way? If so, how is it that they think fecal to oral happens? It seems someone would have to have not washed their hands after passing a stool or cleaning up vomit and then touching food or their/someone else’s mouth. Which would be similar to the scenario I was asking about, wouldn’t it be? Also, I was using oil in the massage which would leave my hands moist, so they weren’t dry and that means his body would have had some moisture too from the oil, would that change anything?

About urine being sterile-I have heard that. I also read a recent article stating it might not be.
https://www.sciencenews.org/blog/gory-d ... r-rest-you

Don’t they do urine tests also in children to find h pylori? If so, doesn’t that mean h pylori is in urine?

How fast does h pylori die at normal room temperature, normal oxygen/co2 measures, and dry conditions?

Thank you again for helping me work through all of this. I sure wish I had a science background. Again, you are very kind to spend this time assisting me.

[Helico_expert]

I am Prof. Marshall research associate. I notice your interesting story. I agree with Helico_scientist that H. pylori dont normally exist in the urine. It is probably not able to survive there. H. pylori is very picky on where it likes to grow. It only grows in the stomach and not in the intestine, and not in the mouth. There are studies that showed scientist able to culture H. pylori from the mouth, I think that's just luck. We have tried many times and failed. I believe H. pylori only stay in the mouth for a very short period of time and then get out compete by the mouth flora.

How long can H. pylori survive outside human body? not particularly sure. But we are unable to culture H. pylori if the sample has been left in room temperature for more than 24 hrs.

The transmission of H. pylori is not completely understood yet. Since most people cannot grow or find viable H. pylori from mouth, the oral-oral route transmission is still a myth. Then again, it has to be going through mouth as it is the only logical path. However, the bacterial load is not known. We dont know how many H. pylori is needed to successfully pass from patient to another.

Nevertheless, H. pylori infection is a very common infection throughout the world. The good news is, H. pylori infection is a very chronic infection and it is relatively easy to treat. The bad news is, there are more pathogens you should be worrying than H. pylori. For example, HPV, candida, neisseria, campylobacter, clostridium that can be contracted if there is poor hygiene.

[Health Inquirer]

Hello Helico Expert & Helico Scientist,

Thank you both for writing me back. I very much value your insight and experience with H Pylori.

I have a few more thoughts and questions about the urine and a couple of other things. I did some more research after your replies to try to understand the h pylori urine tests better. I am wondering if you can help me see if I am understanding this correctly. From what I have read online and from what you are telling me this is what I think I know. There is a urine test that detects h pylori. That urine test is looking for antibodies (the thing that fights off or neutralizes h pylori). That urine test does not look for the antigen and the antigen is the actual h pylori bacteria. Am I understanding that correctly?

Also, from what you are telling me nobody has ever found h pylori antigens in urine, they have only found antibodies, is that correct? Or, have there been h pylori antigens in urine, but it is rare?

Are you able to culture h pylori from antibodies or is h pylori only able to be cultured from antigens?

Do you work with the urine tests for h pylori in your lab?

Also, you were stating that you are unable to culture h pylori if the sample is left at room temperature for more than 24 hours. So, does that mean you have been able to culture it if it was left at normal room temperature/normal oxygen & co2 levels/and dry (all of these conditions together) for 1.5 hours? 3 hours? Or even 6 hours? I am trying to just understand how long it survives. I did find a study from 1996 that shows h pylori survived on plastic for 90 minutes and wood for 30 minutes at normal room temperature, but it was only able to be recultured if it was moist. This is the link to that study if you are curious, http://www.ncbi.nlm.nih.gov/pubmed/9035978.

If I were to have h pylori on my hands and then had massage oil on my hands would the h pylori survive longer because of the moisture from the oil? If so, how much longer do you think it would survive for?

Thank you again for teaching me about how h pylori works. It is incredibly kind of you.
My deepest gratitude to you both.

[Helico_expert]

I must admit that I have not used or seen an Urine test before. I read a few review articles which suggest that urine test is equally good. But without trying myself, I cannot comment further. Based on what I understand, the principle of urine test is to detect the antibody of H. pylori from urine.

anyway, short answers to your questions

That urine test does not look for the antigen and the antigen is the actual h pylori bacteria. Am I understanding that correctly?
antigen comes from bacteria. it may not necessary means the bacteria is viable.

Also, from what you are telling me nobody has ever found h pylori antigens in urine, they have only found antibodies, is that correct? Or, have there been h pylori antigens in urine, but it is rare?
I believe that is the case. H. pylori doesnt have the ability to colonise the bladder.

Are you able to culture h pylori from antibodies or is h pylori only able to be cultured from antigens?
no to both questions.
antibody is a very small protein, more than 10,000x smaller than bacteria. it's like a hair on your skin.
antigen is something antibody recognise and bind to. if you can imagine hair is like antigen, the wax is antibody; then it's like wax sticking to your hair but not your skin.

Do you work with the urine tests for h pylori in your lab?
we do not use urine test for H. pylori
we do or have access to histology, urea breath test, biopsy testing, stool antigen test, PCR gene testing, growing bacteria and blood test.

am i able to culture H. pylori 1.5 hours? 3 hours? Or even 6 hours? later at room temperature?
1.5 hrs, maybe.
3 hrs, a challenge
6 hrs, almost impossible.
reason is not because H. pylori is not there. it is because the contaminant is out growing. So it'll be very difficult to separate H. pylori from the contamination after 6 hrs in room temperature.
also, H. pylori differ from strain to strain. Some easy to grow, some very hard, some grow faster, some require special nutrient, some likes moist. But what you want to know is if H. pylori can survive after long period of time. I dont think there is a good answer anywhere. because it depends on too many factors, eg. bacterial load, moisture, nutrient, competition, etc.

would the h pylori survive longer because of the moisture from the oil? If so, how much longer do you think it would survive for?
again, it's hard to say. Because H. pylori is actually sensitive to many things. eg. salt, vit C, citric acid, chili, garlic, honey etc. all these ingredient kill H. pylori in the laboratory. So I am not sure if H. pylori can survive in the oil you used.


Do ask again if you any more questions.

[Health Inquirer]

Hello Helio Expert,

Wow! Great replies! Thank you so very much for answering all of my questions in great detail. This is very educational and helpful.

Let me see if I am understanding you correctly. I was misunderstanding the difference between culturing h pylori and how long h pylori survives outside of the host. It sounds like from what you are saying you are only able to culture h pylori in normal room temperatures for a short amount of time,
1.5 hrs, maybe
3 hrs, a challenge
6 hrs, almost impossible

You are right, yes I am more wondering once h pylori leaves my body, if it got on my hands for example, how long does it live for? 1 hr, 3 hrs, 6 hrs, 24 hours, or more? I realize it is hard to say because there are so many factors involved, but what do you think or have you noticed in your lab the length of survival once on a dry, normal room temp, and co2/o2 atmosphere surface and perhaps assume whatever the average bacteria load is that one would find on hands say after using the restroom?

As a side note, I am somewhat surprised h pylori does not colonize in the bladder. This site (https://microbewiki.kenyon.edu/index.php/Stomach) states that H. pylori grows best at neutral pH and fails to survive at a pH below 4.0 or above 8.2 in the absence of urea. This site (http://en.wikipedia.org/wiki/Urine#pH) states the pH of urine can vary between 4.6 and 8, with neutral (7) being norm. From reading these comments, it seems the bladder holds the perfect pH environment for h pylori. Why do you think h pylori chooses not to colonize in the bladder?

You were talking about bacteria load, is a lot of bacteria needed to be considered infectious? Do you know how much is needed to be infectious?

Am I understanding correctly that the antigen is the bacteria itself?

And when you say that does not mean the bacteria is viable, you are saying that does not mean that just because you find an antigen(aka bacteria) in a sample that does not mean it is infectious, is that what you are saying?

Also, thank you for telling me some of the things that kill h pylori, that is very helpful to know.

Thank you again for all of your time. I deeply appreciate you and all of your efforts.

[Helico_expert]

I realize it is hard to say because there are so many factors involved, but what do you think or have you noticed in your lab the length of survival once on a dry, normal room temp, and co2/o2 atmosphere surface and perhaps assume whatever the average bacteria load is that one would find on hands say after using the restroom?

Interesting question. But I dont think anyone has the answer. I think it really depends how clean the toilet is, and your hygiene level. eg, close the toilet lid when you are flushing.

As a side note, I am somewhat surprised h pylori does not colonize in the bladder.

Here you are missing an important factor. We call them the adhesin molecule. They are like hands to grab hold on something. So. H. pylori's adhesin molecule can only stick to the stomach wall. In addition, the constant going to the toilet is like constant flushing out liquid in the bladder. So, that add another challenge to all pathogen who has plan to infect the bladder. Surviving in whatever pH, with the right nutrient, and competition are three things. But the ability to stick to the wall and multiply at the very position is the main key to infection.

You were talking about bacteria load, is a lot of bacteria needed to be considered infectious? Do you know how much is needed to be infectious?

unfortunately I dont know. again, i dont think anyone has the answer. H. pylori differ from strain to strain. I wont be surprise if there are strains that infect people in low number and strains that only infect people in high number.

Am I understanding correctly that the antigen is the bacteria itself?

antigen is produced by bacteria. In plain language, you can say it's the appearance of the bacteria. Anything that the antibody can grab, is an antigen. For example, your hair can be grab, so is your hand, your leg, your shirt, your fingers and so on. So, although you find all these limbs, hair, shirts on human, you dont call these limbs, hair, shirts human.

And when you say that does not mean the bacteria is viable, you are saying that does not mean that just because you find an antigen(aka bacteria) in a sample that does not mean it is infectious, is that what you are saying?

Yes, you can find the bacteria, by whatever mean, but not necessary they are infectious. for example, you can find trace of H. pylori DNA in the mouth. It doesnt mean H. pylori is alive there.

[Health Inquirer]

Hello again Helico Expert,

Thank you for that information about the bladder and all of the other information. This knowledge is very helpful for me to know and it helps me understand the process of the body and h pylori much better. Thank you for teaching me. You are the best!!!

You had mentioned some things that kill h pylori like vit c, garlic, and so on. Do you know if vit e, oleic oil, or linoleic oil are things that kill h pylori?

So, from what I understand from all of our communication, there is no rough idea of how long h pylori survives outside of the body in a dry environment and normal temperatures and atmosphere? Not even a rough estimate of for example 1-6 hours, 3-12, or anything like that? And, it is definitely not alive in dry environment at normal temperatures/atmosphere after x amount of hours?

Thank you again so very much for all of your help. I am very fortunate to have found this site. I hope you have a wonderful day.

[Helico_expert]

Do you know if vit e, oleic oil, or linoleic oil are things that kill h pylori?

I do not know specifically if they inhibit growth of helicobacter pylori.but knowing the nature of H. pylori, I dont think they will survive well outside human body, with or without those ingredients.

So, from what I understand from all of our communication, there is no rough idea of how long h pylori survives outside of the body in a dry environment and normal temperatures and atmosphere? Not even a rough estimate of for example 1-6 hours, 3-12, or anything like that? And, it is definitely not alive in dry environment at normal temperatures/atmosphere after x amount of hours?

i dont want to give you false information. So I dont know. Nevertheless, I am pretty certain that they will not live in dry environment at normal temperature.