Helicobacter pylori (H. pylori) infection spreads from person-to-person, however the precise mode of transmission (oral-oral, fecal-oral or gastro-gastric) is hitherto not known. Gaining understanding into the spread of the bacterium might be useful in identifying high-risk populations, especially in areas that have high rates of gastric malignancies or peptic ulcer. In this review, the authors analyze the aspects concerning the plausibility for the fecal-oral route on the basis of the available data.