Helicobacter pylori isolates from different patients are characterized by diversity in the nucleotide sequences of individual genes, variation in genome size, and variation in gene order. Genetic diversity is particularly striking in vacuolating cytotoxin (vacA) alleles. In this study, five open reading frames (ORFs) were identified within a 4.2-kb region downstream from vacA in H. pylori 60190. One of these ORFs was closely related to the virulence-associated protein D (vapD) gene of Dichelobacter nodosus (64.9% nucleotide identity). A probe derived from vapD of H. pylori 60190 hybridized with only 19 (61.3%) of 31 H. pylori strains tested. Sequence analysis of the vapD region in vapD-negative H. pylori strains revealed that there were two different families of ϳ0.5-kb DNA segments, which were both unrelated to vapD. The presence of vapD was not associated with any specific family of vacA alleles. These findings are consistent with a recombinational population structure for H. pylori.Helicobacter pylori is the cause of chronic superficial gastritis in humans. Despite the persistence of H. pylori infection and associated gastric inflammation for many decades, the majority of H. pylori-infected humans remain relatively asymptomatic. However, about 20% of H. pylori-infected persons eventually develop peptic ulcers, and a smaller proportion develop gastric carcinoma or gastric lymphoma (11,(32)(33)(34). The pathophysiologic basis for these disparate outcomes is not yet completely understood, but there is increasing evidence that the clinical consequences of H. pylori infection may be determined, at least in part, by the genetic characteristics of the H. pylori strain with which a person is infected (3,7,13,29).Several lines of evidence indicate that H. pylori is a species characterized by considerable genetic diversity. First, H. pylori isolates from different humans can be readily distinguished by restriction fragment length polymorphism analysis of genomic DNA or specific genes (2,16,17,36) or by randomly amplified polymorphic DNA fingerprinting (1). Second, there is marked variation in the chromosomal maps of different H. pylori isolates (6,22,43). Third, the cag pathogenicity island and insertion sequence elements are present in some strains but not in others (7,21). Finally, multilocus enzyme electrophoresis data indicate that there is colossal allelic variation in this species (20).Genetic diversity among H. pylori isolates is particularly striking in vacuolating cytotoxin (vacA) alleles (3,10,14,35,37,45). vacA has a mosaic structure; it consists of several regions that are conserved and other regions that are highly divergent (3,10,14). Two families of vacA alleles (types m1 and m2) can be differentiated by analysis of the middle region of vacA, and three types of vacA signal sequences (s1a, s1b, and s2) can be differentiated (3). Within one 0.73-kb region of vacA, the nucleotide sequences of type m1 and m2 vacA alleles are only about 70% identical (3).In this study, we analyze a 4.2-kb region downstream fr...