Human saliva seeded with H. pylori was incubated in urea-HCl and then cultured on nonselective media. Pretreatment with 0.06 N HCl-0.08 M urea for 5 min at 37°C resulted in reproducible isolation of H. pylori, even at low inocula (<10 2 CFU/ml of saliva), despite the presence of large numbers of contaminating organisms.The transmission route and source of Helicobacter pylori infection remain unclear. The presence of H. pylori DNA in the oral cavity, feces, and water has been demonstrated using PCR (7,10,17,21), but the culture of H. pylori from these specimens using established methods is quite difficult (1,2,6,18,22). These specimens may contain low numbers of H. pylori organisms (20), which are likely to be overgrown by more abundant populations of rapidly growing competing microorganisms even on selective media. Urease is found in the cytoplasm and on the membrane of H. pylori cells (5,8). Compared to other ureasepositive microorganisms, H. pylori produces larger quantities of highly active urease (5,9,19). Urease hydrolyzes urea, creating a basic "ammonia cloud" around the bacteria, thereby allowing H. pylori to survive at low pH in the presence of urea under conditions similar to those in the stomach (3,12,16). The aim of this study was to develop a new method using short-duration exposures to hydrochloric acid (HCl) plus urea to facilitate the isolation of H. pylori from highly contaminated specimens.Local institutional review board approval for specimen collection was obtained, and patients gave informed written consent. Saliva was obtained from an H. pylori-negative volunteer. Primary H. pylori cultures were obtained from patients undergoing upper endoscopy. H. pylori type strain ATCC 43504 was grown on heart infusion agar with 5% rabbit blood (BBL, Cockeysville, Md.) for 48 h at 37°C under microaerobic conditions (85% N 2 , 10% CO 2 , 5% O 2 ) and then suspended in normal saline for the following assays. First, pure cultures of H. pylori were tested to determine survival in various urea-HCl concentration ranges. Ten microliters of the diluted suspension (ϳ10 5 CFU of H. pylori) was incubated with 5 l of urea and 10 l of HCl at various concentrations for 5 min at room temperature and then serially diluted in 1 ml of phosphatebuffered saline (PBS). One-hundred-microliter aliquots of each dilution were then plated onto heart infusion agar. After the 5-day microaerobic incubation, colonies were counted. Control cultures were carried out using PBS instead of ureaHCl under the same conditions. Additional experiments were conducted to assess incubation time and temperature (4 to 37°C) effects on the survival of H. pylori exposed to urea-HCl. Second, saliva spiked with different concentrations of H. pylori was tested using the procedures above. Optimal urea and HCl concentrations were determined based on H. pylori survival and minimal growth of other microorganisms. Third, the minimum number of H. pylori CFU that could be inoculated into saliva and successfully recovered was determined using the optimal urea-HC...