What is chronic pruritus? Pruritus is a medical term for ‘itch’. Itch is an uncomfortable […]
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Real-life scenario: You may have had an amazing trip overseas, met terrific people, and explored new places, but you start noticing skin rashes [1] and itching upon returning home. Could this be due to bedbug bites, especially since there is a major global resurgence? Or could this be something else — like an STD instead?
In this article, we delve into bedbug bite symptoms, ways to manage these symptoms, and possible differentials besides diagnosing bedbug bites.
Bedbugs, also known as Cimex lectularius, are tiny, brown-reddish insects [2] that hide in the crevices of mattresses, bed frames, headboards, cupboards, or box springs. Although they can come out any time of the day, they tend to creep out at night to feed and suck on the victim’s skin and blood. Bedbug bites and saliva can trigger an immune response in the victim’s skin, leading to an inflammatory response.
Bedbug bites are more common [3] in people with poorer hygiene, lower socioeconomic status, and living in homeless shelters, hotels, and/or hospitals.
In recent months, we have noted a global resurgence of bedbug infestations affecting major cities, including Paris, London, and New York. The adventurous hitchhiker is also making progressive headlines of infestations in Asia countries, including Korea and our beloved home, Singapore.
In more severe cases, one may develop a secondary immune allergic reaction, known as an ‘id’ reaction, with presentation of the following:
If you are experiencing a skin rash and are uncertain of the cause of your condition, do reach out to your physician for evaluation and treatment. Bedbug bites are a treatable condition.
If you are experiencing any bedbug bite or allergic symptoms stated above or are concerned about other differentials such as STDs, please contact your doctor for further evaluation.
Your doctor will obtain a relevant history regarding your rash. Your social history, including recent travel history and sexual history, maybe enquired to aid the diagnosis. Your doctor will then examine the rash, which may involve examining your mouth, eyes, or even your genital region.
Depending on individual conditions, your doctor may offer skin tests in the form of a scrape or swab. If an infection is suspected, further tests in the form of blood and/or urine tests may be offered.
As their name suggests, bedbugs tend to thrive near our sleeping environment. You may be able to find bedbugs infesting [5] the bed, mattresses, headboards, box springs, clothing, cabinet, luggage, carpet, or boxes near your bed.
A recent travel history to bedbug-infested cities may increase the risk of contracting bedbug bites. Individuals who live in dormitories, sheltered homes, cruises, hotels, and/or trains may also be slightly predisposed to bedbug bites.
Bedbug bites are not STDs. As the name suggests, bedbug bites are due to insect bites leading to a skin inflammatory response. In STD, the infection is contracted [6] from sexual intercourse, such as in the form of oral, vaginal, or anal sex. Bedbug bites are not transmissible from one human to another. STDs can be passed on between people if they are not treated and there is sex involved.
Fact of the day: bedbugs do not carry and spread STDs. STDs are transmitted through sexual contact and passed between people. Having said that, rashes caused by STDs occasionally mimic rashes from a bedbug bite. Hence, it is important to consider screening for STDs if there is a risk of exposure.
| STD rash (by condition) | Bedbug bites rash | |
| Syphilis | Widespread red bumps, scaly and itchy. Can mimic any skin condition. | Widespread discrete red bumps, itchy, can be scaly due to repeated scratching |
| HIV | Faint red dots which blanche when touched | Red bumps which tend to be raised, palpable, and itchy but can mimic HIV rash |
| Scabies | Red itchy bumps, excoriated, with mite ‘burrows’ seen | Red, itchy bumps, excoriated, can be linear in appearance – like scabies |
| Herpes | Grouped or clustered blisters (fluid-filled lesions) | In severe bedbug bites, blisters can be seen as part of an allergic response or as a result of intense scratching |
| Chlamydia Gonorrhoea | Can occasionally present with pustules (white) bumps | Less commonly present with pustules- though this may occur as a result of secondary bacterial infection |
Bear in mind the appearance of the rash for both bedbug bites and STDs can be medically quite technical. Sometimes, even a trained pair of eyes can find it difficult to differentiate between them.
The suspected differential can be confirmed or ruled out through appropriate tests. Discuss with your doctor whether appropriate tests are required for your skin presentation.
Thankfully, most bedbug bites are not dangerous. Treatment includes antihistamines, topical steroids, and soothing moisturiser. In severe cases of bedbug bites, especially with an allergic reaction, your doctor may prescribe a short course of oral steroids to clear off the symptoms. Oral antibiotics may be considered for individuals with secondary bacterial infections.
Affected clothing or objects should be washed at a high temperature, around 60℃ and tumble dried at a high temperature. Placing affected items in an extremely cold environment, such as the freezer (-18℃), is another method to eradicate bedbugs.
You may consider contacting pest control services to eradicate bedbugs from your living space effectively.
The fun fact of the day: bedbugs tend to bite over exposed areas of the skin; they seldom burrow beneath clothing. Wearing covered/long-sleeved clothing or pyjamas may reduce the chances of getting bitten by bedbugs.
When you are living abroad or in a hotel, check for bedbugs! Inspect the crevices of the bed(s) or mattress(es) for possible bedbugs or bedbug particles. Place your bags and luggage on the dressers or luggage rack, keeping them away from the bed. If you suspect bedbugs are in your belongings after travelling, you can consider placing them in a plastic ziplock bag and sealing them up.
When you return home from abroad, unpack your luggage or bags on concrete/solid surfaces such as the bathroom floor, garage, or at the entrance.
It is reassuring to know that there are effective medical options for managing the symptoms secondary to both bedbug bites and other disguised diagnoses such as STDs. Being safe is key. Reach out to your medical physicians for further consultation and to confirm your skin diagnosis.
What is chronic pruritus? Pruritus is a medical term for ‘itch’. Itch is an uncomfortable […]
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