Bed bugs can go without feeding for 20 to 400 days, depending on temperature and humidity. Older stages of nymphs can survive longer without feeding than younger ones, and adults have survived without food for more than 400 days in our home's at low temperatures. Adults may live up to one year or more, and there can be up to four successive generations per year. Bed bugs feed on humans, usually at night when they are resting. This insect feeds by piercing the skin with its elongated mouthpart, which consists of four stylets that normally fold under its body when at rest but fully extend during blood feeding. Two maxillary stylets form canals, a small salivary canal that carries saliva into the wound and a relatively large food canal through which body fluids from the host are taken in. A bed bug can take up to six times its weight in blood during one feeding event, which takes between 3 and 10 minutes. Usually people aren’t aware they have been bitten until afterward; bites occur while people sleep, and bed bugs are known to inject a natural anesthetic while feeding. However, saliva injected during the feeding can later produce allergic dermal reactions such as large itchy swellings on the skin. These may become irritated and infected when scratched. Swelling may not develop until a day or more after feeding, and some people show no symptoms at all. Bed bugs have never been shown to transmit human disease. Distinguishing bed bug bites from the bites of other arthropods such as mosquitoes, fleas, and spiders is difficult to impossible. People often confuse itching bed bug welts with mosquito bites. The only way you can really confirm bed bugs as the cause is to find the bugs or their signs in your bed or bedroom. Often people are bitten when traveling and may be unable to produce a specimen, making diagnosis even more difficult. In addition to direct injury to humans, bed bugs leave odors and unsightly fecal spots on bed sheets and around the insects’ hiding places. These spots are usually reddish brown or dark brown to black, sometimes yellowish, roughly round (although sometimes they appear as streaks), and can be very small.

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