Helicobacter pylori infection is responsible for considerable morbidity and mortality rates worldwide due to gastric ulcers and they’re inevitable complications. Furthermore eradication rates have been steadily declining globally due to an increase in antibiotic resistance as well as the bacteria’s multitude of immune evading behaviours. This discussion is an overview of the multifaceted aspects of Helicobacter pylori, including the common challenges faced by clinical laboratories when trying to grow, isolate and perform standard sensitivity testing. There is a retrospective analysis of resistance trends using data obtained from a large clinical laboratory. Lastly we discuss new technologies including molecular advancements that have revolutionised sensitivity testing and enabled scientists to shine a light on resistance mechanisms and the inevitable arms race between helicobacter pylori and antimicrobial agents.