Introduction: Helicobacter pylori (H. pylori) is the causative agent of chronic gastritis and peptic ulcer diseases with associated risk factor of developing gastric cancer and mucosal-associated lymphoid tissue (MALT) lymphoma if left untreated. In this study, we evaluated the prevalence of virulence genes and associated risk factors of H. pylori among adults in a gastric cancer risk region of Nasarawa State, North central Nigeria. Methods: This was a descriptive cross-sectional study to determine H. Pylori status of 434 adults in gastric cancer high risk region of Nasarawa State from January to August, 2021. Associated risk factors and virulence genes (positive/β-(1, 3) galT of jhp0562, cagA, vacA, and hrgA) was evaluated from gastric biopsy specimens of dyspepsia patients. Results: The overall prevalence of H. pylori infection was 45.6% (198/434). The rate of infection was higher in male subjects (40.6%) than in female (23.8%); P<0.001) and higher significantly among adults with the following associated risk factors: unboil water, consumption of alcohol, low income, and Urban residency. Unboiled water consumption and alcohol consumption were independent risk factors for H. pylori infection (odds ratio=7.48 vs OR=9.78 respectively). Of the 198 strains cultured, 76.9% carried Western-type cagA, with a higher proportion in Male (86.4%) than in Female (50.0%), P=0.05). Patients infected with East Asian-type cagA strains (P=0.027) have lesser inflammation scores in the antrum than those infected with the Western-type cagA strains. Conclusion: Our study revealed a high prevalence of H. pylori infection in Nasarawa State, with unclean water source, and alcohol consumption as significant risk factors for H. pylori infection. The incidence of gastric cancer in Nasarawa State is associated with circulating virulence genes of cagA, vacA, hrgA and jhp0562-positive/β-(1, 3) galT.