I'm glad you understand the BFP situation, and that you now seem to realize you do not have syphilis and never did. That your PCP cannot explain the situation suggests he or she has poor understanding of syphilis. It wasn't necessarily wrong to treat you for presumptive syphilis when you first sought care, because of the reactive RPR. But you should have been told the diagnosis of syphilis was not certain and that the confirmatory test would be necessary.

BFP results sometimes are temporary, but it's often a permanent condition. It can occur as a result of some drug reactions, and it's more common in pregnant than non pregnant women. Very rarely it occurs in people with inflammatory conditions like rheumatoid arthritis, systemic lupus, and others -- but without typical symptoms (joint pains, skin rash, unexplained fever) these are unlikely. In the event you require syphilis testing in the future, ask your doctor or clinic to use one of the newer IgG/IgM antibody tests for screening and not RPR or VDRL.

As for the cause of the penile lesion that started all this, I have no way of knowing. However, the most common cause of genital skin ulcers is herpes. In the event of recurrence of anything similar in the future, you should be evaluated for HSV infection. But bacterial or fungal infections or minor injury also are possible. 

1. So in other words my TPPA for testing is 100%? The chances of a false negative this time is virtually zero?

2. Have you ever heard of PEP (generic Biktarvy form India) causing reactive RPR (I just stopped my 28 days one week ago)? Could a minor viral or bacterial infection cause this? I'm mostly perplexed/curious to learn more about this (I had a RPR in 2018 that was non reactive).
3. Thanks - based on past thread with Dr Hook I had ruled out HSV because I did not see this in the first 10 days, it never hurt, never itched, never formed a head, and multiple did not occur. If it were you in this position - what would you think it is? Is it worth pursuing a dermatologist? I'm worried about passing something on to future partners.

Again, I can't thank you enough. It's been difficult finding PCP who can speak to this This has been an invaluable resource and I will try to provide final updates to my results so that others can benefit from it. 

2. I am unaware of data on any anti-HIV drugs causing BFP. In the nearly 100 years since BFP was first understood, other minor infections have been suspected to explain some cases, but to my knowledge there is no scientific documentation of this.

3. Absence of those symptoms argues against HSV as the cause, but is not proof by any means; atypical cases are common. I would not explore the issue with a dermatologist at this time, but would do so (within a day or two) in event of recurrence of a similar lesion or other genital blisters or sore of any kind.

1. Is it reasonable to think the RPR reactive is benign then and I have nothing to worry about moving forward? I'm trying to make sense if it's reasonable for me to feel as if this marking was not a STI and I did catch not anything from this exposure (insertive oral).

2. If HSV can be atypical like this, should I consider taking a HSV blood test? Are the results always unreliable? Or would it have a good chance of picking it up IF this was HSV?

3. When can I consider myself safe to start having intercourse again?

Again, sorry for specific questions here - this has been a lot to learn. And thank you again.

2. Yes you could be tested for HSV but not until at least 3 months after onset of the lesion. A negative HSV2 result would be conclusive and reassuring. But HSV1 testing is inherently less reliable and often gives uncertain or difficult to interpret results.

3. Whenever you want. Now is just fine.