<i>Introduction</i>: <i>Helicobacter pylori (H. pylori</i>) 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 <i>H. pylori</i> among adults in a gastric cancer risk region of Nasarawa State, North central Nigeria. <i>Methods</i>: This was a descriptive cross-sectional study to determine <i>H. Pylori</i> 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. <i>Results</i>: The overall prevalence of <i>H. pylori</i> 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. Un-boiled water consumption and alcohol consumption were independent risk factors for <i>H. pylori</i> 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. <i>Conclusion</i>: Our study revealed a high prevalence of <i>H. pylori</i> infection in Nasarawa State, with unclean water source, and alcohol consumption as significant risk factors for <i>H. pylori</i> 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.