1. Why did the outbreak occur in different area. Is it possible I gave to my fiancé and he spread it back to me in a different area?

2. I also become extremely paranoid with this diagnosis and it has taken over my life.  I always think that I will now spread the infection to multiple parts of my body. This morning I noticed a small whiteish/red bump on eyelid and I’m now concerned I spread my HSV 1 to me eye, 

Should I be concerned??

It is completely and totally normal for outbreaks to show up in different areas of the genital - and even the buttocks or thigh and lower belly.  These are all areas innervated by the same group of nerve that innervates the genitals.  So you should not be at all concerned about this.

Once you have HSV 1 in one location (in your case, the genital area) it would be extremely unlikely that you would spread it to a new location on your body.  Extremely unlikely.  Have you ever had a cold sore in your lifetime?  Did you have one when you contracted genital HSV 1 in 2007?  If not, then it is most likely that you don't have oral herpes (the nerves there supply the eye area). 

Terri

Terri

As you have experienced, genital HSV1 usually recurs infrequently and asymptomatic viral shedding also is quite uncommon. Therefore genital to genital HSV1 transmission appears to be rare; Terri says she has never seen a case. This could change, as the frequency of genital HSV1 has been rising. But statistically, there's at least a 50% chance your partner already has had HSV1, in which case he is resistant and perhaps immune to a new infection. If you are careful to avoid sex during one of your rare recurrent genital outbreaks, he will be at little risk. For those reasons, suppressive therapy isn't usually advised for patients with genital HSV1, unlike HSV2. That said, it might help reassure your partner, which might be psychogically beneficial to you, and side effects or toxicity from valacyclovir are very rare. On the other hand, you would have marginal benefit at the cost or taking a drug for years -- perhaps with each dose reminding you of your herpes! 

Let's see what Terri says when she's back. It shouldn't be long.

HHH, MD

Also, I’m running into the issue where I’ve had two swab tests that came back positive for HSV 1 and two that came back negative. Is there anyway the diagnosis was wrong? The nurse practitioner that told me the culture was positive this time also said she doesn’t think it’s an active lesion she thinks it’s excoriation and that I only tested positive because I have a history of it. This was very confusing to me. I also was asymptomatic this time I only knew because when I wiped it hurt a little bit. 

Yes, two indeterminates on the blot should be considered a negative and no further testing will help.  I have yet to see anyone with an indeterminate on the blot come back positive on the repeat draw IF they waited 12 weeks after a concerning encounter to do the test AND have not taken a long course of antiviral medication prior to testing.

Your NP is incorrect - the swab testis positive because virus is present.  We can get positive swab tests from completely normal looking skin because the virus can be shed from the body when someone has a classic outbreak or not.  And really, I'm not sure the distinction is important that she's making - swabs are not positive unless virus is present.  Period.  So this leads into the second question 0 how long after an outbreak can you have sex.  There is no magic answer here because you can give off virus when you aren't having an outbreak that you recognize.  But in general, I would say you can have sex again when the skin looks normal, knowing that that isn't a perfect indicator of viral shedding - or not shedding.

Terri