Helicobacter pylori increases the risk of gastric cancer by six times. This study aims to assess the prevalence of Helicobacter pylori infection among sewage workers, and to evaluate Western blot and H. pylori (IgG & IgA) antibodies against stool antigen for diagnosis of Helicobacter pylori infection. Cross sectional study was carried out on 90 male sewage workers in Abo-Rawash municipal wastewater treatment plant located in Egypt, from 2017 to 2019. All participants filled in a questionnaire. H. pylori IgG, IgA antibodies test, and Western blot IgG test against 13 antigens of Helicobacter pylori and H. pylori antigen in stool were done. Presence of gastrointestinal symptoms was observed in 5.6% to 38.9% sewage workers. The seroprevalence of H. pylori IgG and IgA are 87.8% and 47.8%, respectively. Sewage workers were divided into administrators, operators and laboratory workers. The highest percent of chronic and current Helicobacter pylori infections were among the administrator group, and the lowest were among the laboratory workers. The prevalence of H. pylori antigen in stool is 46.7%. About 8.9% of the workers with positive H. pylori stool antigen are negative for serum H. pylori IgA, 4.4% are borderline and 33.3% are positive, while all the workers with positive H. pylori stool antigen show positive serum H. pylori IgG. Serum H. pylori IgA and IgG antibodies are significantly higher among those with positive H. pylori stool antigen. Workers with positive serum H. pylori IgG showed higher percentage of symptoms compared to those with negative or borderline serum H. pylori IgG or those with positive serum H. pylori IgA. Serum level of H. pylori IgG is significantly higher among workers who have positive virulent strains except for p33. H. Pylori IgG assay is an excellent test that can be used to predict H. pylori infection. The serological investigation of antibodies to H. pylori using the anti-H. pylori enzyme-linked immunosorbent assay (IgG, IgA) and/or the anti-H. pylori western blot (IgG), may represent the diagnostically most-reliable and inexpensive method for the diagnosis of H. pylori infections.