If [the] patient has ​H. pylori​ and is asymptomatic, doesn’t have access to the virulence test, and may or may not have the risk factors, if not serious risk factors, then leave it, if serious risk factors, then treat [it] as a judgment call?

Yes, I think that’s reasonable. I also forgot to mention age as a factor. Dr. Martin Blaser, who wrote the book, ​Missing Microbes​, which I highly recommend, has argued that ​H. pylori,​ if it’s acquired early in infancy or early childhood, can actually protect against the development of allergies and autoimmune disease, asthma, etc. So, if we’re testing, like, a very young child, for example, and they have ​H. pylori​, I’d be a lot less likely to treat it than I would be if we [found] it in a 65- or 70-year-old person because we know that ​H. pylori​ increasingly becomes a risk factor as we age, so that’s another consideration.