* If this infection is genital, I know it rarely sheds but it still seems inevitable that my wife will come in contact with shedding virus. If I am infected genitally it would have to be from 2014 from my last relationship.Is it possible that after so long that I may not be shedding at all or shedding such low amounts that it isn’t a risk to her?
It is not inevitable that you wife would acquire HSV 1 from you if you have genital HSV 1, not at all. If you have it genitally, it is likely very very rarely shed at this point
* In 2018, I was on a beach vacation and my meatus became very swollen and irritated. I think it might have been from rubbing against the mesh of my swim trunks, but I have this nagging fear that it might have been herpes. The meatus was red and kinda looked puffy, but I didn’t see any blisters or ulcers, nor did my wife. Could this be an atypical presentation of herpes?
Doesn’t sound like it to me.
* A couple years ago, I had a spot on my lip that turned yellow and scabby, but I had been messing with it. It was right in the center of my lip, not on the edge. Could this have been a cold sore?
* I had another spot on my lip that looked like little white dots under the skin, they were not fordyce spots and this was also in the center of my lip. I don’t recall it blistering or ulcerating, but I might not have been paying close enough attention. Could that have been aborted outbreak?
* I have two grandmothers that get cold sores and my two older siblings do, statistically is it more likely that this an oral infection?
I don’t know that that is true, not necessarily
*My IGG score was 21 for HSV1, does that indicate how long I’ve had the infection. Like would it be higher if i was infected from childhood vs 2014?
No, whether you were infected at childhood or in 2014, this number does not help to make that distinction
* Is it possible to get cold sores in childhood and then not get them or have symptoms as an adult?
* My wife and I have been together since 2017 and since 2018 we have been having unprotected sex, I recently requested that she get a Western Blot to have a solid baseline. I don’t perform oral sex on her. If this is genital and she’s went this long without contracting, it likely she won’t every contract it genitally from me?
I would say there is an excellent chance she won’t get it from you if you have it genitally
* I saw on another post where you recommended 24/7 labs swabs for herpes? Are these PCR? Do you think it would be worth it for me to genital swabbing or is unlikely to yield anything?
I had a patient who tested positive for HSV 1 with no known lesions in either location (that is not true for you – you had a lip lesion). He swabbed every day for a year with none that were positive. I would say that if you have a symptom, you could order this kit but if not, I think it is an exercise in futility to swab genitally.