Ashley Clay, MSPAS, PA-C
What are brown, blood-sucking, roughly the size of an apple seed and the width of a credit card, have the ability to survive in extreme conditions (from nearly-freezing temperatures to 113o Fahrenheit), are located in all 50 states and across the globe, can live months without feeding, can bite you without your knowledge, and after feeding, like to hide in dark areas for 5 – 10 days while digesting their meal, mating, and laying eggs?1
What is the appearance of a bed bug?
The common bed bug (Cimex lectularius) is brown, wingless with two antennas and six legs, approximately 1/4’’ in size, flat (prior to feeding), broad and oval in shape.2 They feed on any warm-blooded animals, even birds, but prefer humans. After feeding, bed bugs turn red in color and can significantly increase in size—expanding 200% in weight and 50% in length.3
How long do bed bugs live?
The life cycle of a bed bug consists of different stages:4
Bed bug eggs are approximately 1 mm in size—the size of a pinhead—and pearl-white in color. Female bed bugs lay approximately five eggs per day (ranging from 200 to 500 per lifetime). The eggs hatch within 4 – 10 days.5 After hatching, the egg shells may be visible on surfaces where they are hiding (indicating to you that there is an infestation). These egg shells have the appearance of small, thin popcorn kernels.
Young/Immature Bed Bugs
Young or immature bed bugs are also called “nymphs.” There are five classifications/stages
of young bed bugs. In order to advance to the next nymph-stage, the bed bug
must molt (shed) its exoskeleton.6 This shedding occurs 5 times before they are adults. In order to molt and
advance to the next stage, they require a blood meal each time. Nymph bed bugs
range in size from 1.5 mm to 4.5 mm. They are translucent to white/yellow in
color and nearly invisible to the naked eye.
Adult/Mature Bed Bugs
Adult bed bugs are about 7 mm, roughly the size of Lincoln’s head on a penny, meaning they can be easily seen by the naked eye. Once at the adult stage, bed bugs no longer have to shed (molt) their skin. They can crawl more than 100 feet in a night but typically live within 8 feet of the humans they are feeding on.7 They smell sweet and musty, live 6-12 months, and can go long periods without feeding, but they will feed every 5 to 7 days if a host is present.8
What do bed bugs eat and how do I know if I’ve been bitten?
These pesky insects consume only blood, preferring human blood—this is accomplished by inserting a long, sharp probe (proboscis) into the exposed skin of their victim,generally when we are asleep.9 Areas of the body commonly affected include the face, neck, arms, hands, and legs. Interestingly, we often do not feel the bite because the bug injects its saliva which acts as an anesthetic (numbing agent), keeping us from feeling the bite and moving.10 The saliva also keeps the blood from clotting, allowing ample time for them to get full. You may not have any signs of a bite immediately after you have been bitten, it can take one to several days before you notice any changes to your skin.11
Characteristic appearances and symptoms of bite(s) include:
- Red, raised, slightly swollen bump that becomes itchy and can be irritating
- You may experience anxiety and difficulty sleeping
- Secondary skin symptoms or issues due to extreme scratching
It takes between 5 to 10 minutes for the critter to get engorged with blood—which can satisfy them for days. Jokingly, the bite marks left behind are often referred to as “breakfast, lunch, and dinner” because they are often clustered together in a linear pattern.12 The bite they leave behind can vary from person to person and often mimic bites from other insects (mosquitos or fleas), making it difficult to know what has exactly bitten you. Some individuals will not have any signs of a bite.
How are these bites treated?
If you discover that bed bugs have hitched a ride to your house and you have been bitten—do not panic! Typically, bed bugs do not pose a serious health risk;13 however, it is important to avoid scratching. To relieve itching symptoms, consider an antihistamine and an antiseptic lotion or cream (if you are able to tolerate these and have no contraindications to these medications). Over-the-counter medication/treatment options include:
- An oral antihistamine such as diphenhydramine (Benadryl)
- Skin creams containing hydrocortisone
If you develop a skin infection from scratching, your health care professional may prescribe an antibiotic.
If you experience an allergic reaction, have several bites, or the
wounds begin to look infected seek advice from your healthcare provider. In the
rare event of an anaphylactic reaction, (symptoms may include difficulty
breathing, swallowing, or talking, wheezing, swelling of your lips, throat, or
face) contact your local emergency service (911).
Can bed bugs transmit diseases?
Bed bugs have not been shown to transmit disease; however, secondary to the variety of negative physical and mental health and economic consequences,14 the Environmental Protection Agency (EPA) classifies them as a public health issue and a “pest of significant health importance.”15 This means they are widely recognized as potentially posing a risk to a significant number of people requiring governmental agencies to implement programs to combat and control these pests. A variety of other creatures make the list, a few examples include ticks, cockroaches, lice, rats, chipmunks, raccoons, and skunks.
It is important to note that although bed bugs cannot transmit diseases, they can exacerbate certain medical conditions; for example, bed bugs are known to cause flare ups of asthma.16
Who is at risk for getting bed bugs?
Everyone is at risk for bed bug infestations—they are small, very good travelers, and hide well. If a bed bug infestation occurs at your home, it does not mean that you or your house are dirty—they infect both clean and dirty places alike. People who travel tend to be more susceptible and most are never aware they are transporting bed bugs when traveling to and from different areas—infecting locations along the way and ultimately bringing them back to their own house.
Bed bugs hide in small, dark places such as luggage, bedding, clothing, and furniture—commonly they are found in areas of overcrowding or where people share living and sleeping spaces, such as:
- Hotel rooms or hostels
- Homeless shelters
- Cruise ships
Common physical findings of a bed bug infestation include: 17
- Presence of live bed bugs in mattresses or sheets
- Fecal remnants (rusty-colored blood spots) left behind on sheets or furniture
Common locations in the home where bed bugs are found hiding include:18
- Warm, dark environments
- Cracks, crevices, and seams (think couches, mattresses, box springs, between cushions, etc.)
- Tags on mattress
- Cracks on bedframes or headboards
- In the head of screws
- Areas of clutter, boxes
- Loose wallpaper or wall hangings
- Where the wall and ceiling meet
- Electrical receptacles
A definitive way to determine an infestation is to visually see the bug. There are a variety of websites that will allow you to compare pictures as well as trained professionals who can confirm their presence. If you find what you think is a bed bug, you can confirm this by checking the EPA website OR check with your local extension agent who is trained in pest control issues.
How do you eradicate bed bugs?
You may be able to get rid of them on your own; however, often professional help is needed. The earlier you detect and remove them impact the ease and cost—it’s much easier to treat a small infestation rather than a large one.19
Methods you can attempt to try to eliminate bed bugs include:20
- Vacuum all areas of your house. Once you’re finished, carefully empty contents in a plastic bag and throw away—then thoroughly clean your vacuum.
- Move your bed at least 6 inches away from the wall.
- Seal, glue, tape, or caulk open areas. This includes wallpaper, cracks in furniture or baseboards, open electrical outlets.
- De-clutter. Throw out old magazines, books, and other places bed bugs may hide. Do not move items from an infested area to a clean area. You will likely re-contaminate the bed bug free places
- Launder all clothing and linens. Use hot water and the high heat setting on your dryer. This will likely kill the bed bugs hiding there.
- If the items cannot be laundered, place them in a plastic bag. Place the sealed bags outside or in a hot car when the weather is above 95 o F. Leave items in the sealed bag for several months. You can also attempt placing the sealed bags in the freezer at 0o F. It is recommended to leave them in there for at least 4 days.
- Use a steamer on furniture such as couches or mattresses.
- You may also need to throw away heavily infested items, such as mattresses or furniture that you cannot clean. When tossing out these items, make sure to spray paint or label the words “bed bugs” on the outside so others won’t try to take them home. Once your mattress and box spring are free of bed bugs, purchase protective covers.
- Insecticides are chemical treatments available for purchase.21 Buy products that are EPA-registered and specifically labeled to treat bed bugs. Pyrethrins and pyrethroids are most commonly used and indicated for indoor use. Be aware that bed bugs are starting to become resistant to these modalities. The majority of consumer-use products are formulated using pyrethroid chemistry which is largely because of the overall safety of the active ingredients. Examples include indoor foggers or bug bombs; however, these products are not known to be 100% effective. No single insecticide can eradicate a bed bug infestation if used alone. A common mistake consumers make is to set off several bug bombs in their home in attempts to eradicate bed bugs. This is VERY dangerous: Several reports reveal homeowners have blown out windows after setting off multiple bug bombs (due to the increase in interior pressure).
If you are unsuccessful at eliminating the bed bugs cohabitating with you, it would be wise to contact a professional exterminator; they will likely use a combination pesticides and non-chemical treatments to eradicate the bugs.22 They are often difficult to get rid of and can take several weeks of treatment. Professional treatments can take two or three visits to be effective.
Bed bugs can survive in harsh environments, living and remaining active at temperatures as low as 46o F and as high as 113o F. Professional exterminators may also bring in equipment that can heat entire rooms to temperatures that exceed the threshold that bed bugs can survive.23
How do you prevent a bed bug infestation?
Protect Your Home
Everyone should be knowledgeable about areas where bed bugs tend to live, ways in which they spread, and measures to prevent a bed bug infestation—this is especially true for frequent travelers or individuals who share common areas. Additionally, homeowners should be aware of signs of infestations, mindful of clutter, and aware of ways to protect themselves in public areas, while traveling, or when purchasing new or used items.
Protect Yourself in Public Places and Common Areas24
Laundromat. When a bed bug infestation occurs, people are instructed to wash/dry articles—because of the volume of items that need laundered, people will often go to the nearest laundromat. The bed bugs that find themselves in the washer and dryer will likely not survive; however, you should be mindful of those that may be left in the bags used to transport laundry and ultimately end up in the trash: Those hungry bugs could find their way into your clean clothes. Pay attention to your surroundings. To protect your belongings when going to the laundromat, you should transport items in white plastic bags—this makes spotting bugs much easier. Do not set your laundry basket on the floor, on top of the washer, near trash cans, or seating areas; take it back to your car. It is recommended to fold your laundry at home; however, if you must fold at the laundry mat—inspect the table thoroughly before laying out your clothes.
Other areas. Other areas to be vigilant include libraries, gyms, department stores, offices, storage areas (coat closets or coat checks), schools—each of these types of places can be infested and a major highway for transporting bed bugs back to your home. Things to remember in these areas:
- Keep personal belongings off of the floor and out of lockers where multiple people have access
- Educate staff and co-workers regarding bed bugs and ways they are transmitted
- If a bed bug is found—do not panic but do notify management immediately
Protect Yourself When You Travel
When you stay at hotel, motel, or hostel, check bed sheets, mattress tags, and headboards for rusty-colored spots and bugs. Carry a small flashlight to check for bed bugs. Cover suitcases in plastic. Keep them off the floor. Inspect the luggage stand before placing suitcases or bags. Move the luggage stand away from the wall. Place shoes in an open area and not in the closet or under the bed. Avoid unpacking your belongings, instead leave them in the plastic and keep the plastic closed. When you return home wash all clothing in hot water and dry on a high heat setting (this is even recommended for clothes that you did not wear). Consider traveling with a duffle bag that can be laundered when you return home. This avoids the possibility of your suitcase becoming contaminated.
Protect Yourself When Buying Second-hand Furniture and Supplies25
If purchasing at a store that sells used furniture and supplies, be mindful and carefully inspect each item before you take it home. Items that often get overlooked and can harbor bed bugs include: books, records, and wall hangings. Avoid renting or borrowing furniture. When purchasing a new mattress, do not have it delivered; trucks delivering the mattresses often haul away the old one as a courtesy. Avoid picking up furniture or mattresses from dumpsters.
Know the Law
In addition to rules and regulations regulated by the EPA surrounding pesticides,26 there are also regulations regarding the reporting and management of bed bug infestations.27 Laws may be specific to your state; view the National Pest Management Association – State Bed Bug Laws. There are state-specific requirements for a variety of establishments; examples include rental properties, hotels, city and town halls, vacation properties, orphanages, migrant labor camps, guest rooms, and public housing.
Bed Bugs Bite
What bit me? You may be asking yourself this if you have a new rash or itchy red bumps. Immediately you may question if bed bugs, scabies, fleas, ticks, spiders, or lice are the culprit. Now that you have finished this article, you are aware how to avoid letting the bed bugs bite.
article is not intended to diagnose or treat any condition or to give medical
advice. Always consult your healthcare provider for healthcare instructions.
External links are provided as references and do not indicate an endorsement by
1 PestWorld.org, “Six Facts You Didn’t Know About Bed Bugs,” https://www.pestworld.org/news-hub/pest-articles/six-facts-you-didnt-know-about-bed-bugs/
3 Megan Gannon, “Bedbugs: Facts, Bites and Infestation,” LiveScience, https://www.livescience.com/42297-bed-bugs-facts-information.html
4 United States Environmental Protection Agency, “Bed Bugs Appearance and Life Cycle,” https://www.epa.gov/bedbugs/bed-bugs-appearance-and-life-cycle
7 “Bedbugs: Facts, Bites and Infestation.”
8 “Bed Bugs FAQs.”
9 “Bedbugs: Facts, Bites and Infestation.”
10 “Bed Bug Facts for Kids.”
11 “Bed Bugs FAQs.”
12 “Six Facts You Didn’t Know About Bed Bugs.”
13 “Bed Bugs FAQs.”
14 United States Environmental Protection Agency, “Bed Bugs: A Public Health Issue,” https://www.epa.gov/bedbugs/bed-bugs-public-health-issue
15 United States Environmental Protection Agency, “Pesticide Registration (PR Notice) Notice 2002-1,” https://www.epa.gov/sites/production/files/2014-04/documents/pr2002-1.pdf
17 “Bed Bugs FAQs.”
19 Healthline, “How to Get Rid of Bedbugs,” https://www.healthline.com/health/healthy-home-guide/how-to-get-rid-of-bed-bugs
21 Dini M. Miller, “Bed Bug Treatment Using Insecticides,” Virginia Tech, http://www.vdacs.virginia.gov/pdf/bb-treatment1.pdf
22 Mayo Clinic, “Bedbugs,” https://www.mayoclinic.org/diseases-conditions/bedbugs/diagnosis-treatment/drc-20370005
23 “How to Get Rid of Bedbugs.”
24 United States Environmental Protection Agency, “Protecting Yourself from Bed Bugs in Public Places,” https://www.epa.gov/bedbugs/protecting-yourself-bed-bugs-public-places
25 Dini M. Miller, “Bed Bug Prevention Methods,” Virginia Tech, http://www.vdacs.virginia.gov/pdf/bb-prevention1.pdf
26 United States Environmental Protection Agency, “Bed Bug Laws and Regulations,” https://www.epa.gov/bedbugs/bed-bug-laws-and-regulations
27 National Pest Management Association, “State Bed Bug Laws,” https://www.epa.gov/sites/production/files/2016-11/documents/state-bed-bug-laws.pdf