Small red dots on the glans and the coronal sulcus are likely to be a sign of a stage 1 syphilis chancre, but a laboratory test is needed to make a definitive diagnosis. The hard chancre is a painless inflammatory reaction caused by the syphilis spirochete at the site of invasion. It is prevalent in the external genitalia, and in males it is most commonly found on the penis, the coronal groove, the glans, the prepuce and the tethered ligament. The typical chancre begins as a small erythematous patch that rapidly develops into a painless inflammatory papule, which enlarges to form a hard nodule within a few days, with necrosis occurring on the surface and forming a single painless ulcer 1-2 cm in diameter, with a clear border, peripheral oedema and elevation, and a fleshy red base, with cartilaginous hardness to touch, and a plasma secretion on the surface containing a large number of syphilitic spirochetes, which is highly contagious and often single, sometimes 2-3 can be seen. The untreated chancre may persist for 3-4 weeks and then subside on its own.