Detection of infestations
Bedbugs can be detected often by looking for dark stains on bedding, which are the bedbugs' fecal stains. Occasionally an engorged bedbug is killed or crushed, resulting in a visible smear of blood and a sickly-sweet odor, which is often detectable in large infestations. Though bedbug bites can occur singly, they often follow a distinctive pattern of a linear group of three bites, sometimes jokingly referred to as "breakfast, lunch and dinner". These patterns of bites are caused when a bedbug is disturbed in feeding by a person moving, and then the bedbug resumes feeding. The effect of these bites on humans varies from person to person, but often cause welts and swelling that are more itchy and longer-lasting than mosquito bites. Some people, however, have little or no reaction to bedbug bites. Those whose bodies do not initially react may subsequently develop symptoms, however, due to an allergic reaction caused by the development of antigen.

With the widespread use of DDT in the 1940s and '50s, bedbugs all but disappeared from North America in the mid-twentieth century. Infestations remained common in many other parts of the world, however, and in recent years have begun to rebound in North America. Reappearance of bedbugs in the developed world has presented new challenges for pest control, and, without DDT and similarly banned agents, no fully effective treatment is now in use.

Contrary to popularly disseminated information, extreme heat or extreme cold is usually not effective in eliminating bedbugs. Pest control professionals receive reports of infestations even in the dead of winter, and manufactured environments of extreme heat or cold (such as encasing a mattress in a bag and placing it in direct sunlight, or placing a suspect piece of bedding or clothing in a freezer) usually cannot stay consistently hot or cold enough to kill bedbugs. The National Pest Management Association can assist in the location of pest control professionals.

An informal survey of pest control professionals conducted by a pest control professor at the University of Massachusetts stated that 68% of all bedbug infestations require three or more treatments, 26% require two treatments, and 6% require just one. However, this survey does not seem to have taken into account the size of the infestation, the size of the venue being treated, the extensiveness of that venue's preparation for the treatment (thus enabling or inhibiting coverage of the poisons), the skill of the exterminator, whether popular nesting places have been disposed of, and the cause behind the original infestation.

Most reputable pest control professionals require that the domicile be prepared by residents prior to their arrival for a chemical treatment. If an apartment is not properly prepared either by the resident or the professional, the coverage of pesticides and/or chemical treatment throughout the domicile will be impaired, and thus the effectiveness of the treatment will be heavily reduced. All furniture and appliances in the dwelling usually need to be pulled away from the baseboards, and it is commonly asked that all furniture containing potential hiding crevices, such as bookshelves and desks, be emptied and left open for the exterminator to spray. Items in tightly sealed containers are usually safe from bedbug infestation and need not be emptied.

Everything possible should be laundered, such as clothing, rugs and stuffed toys. For maximum effect, laundry should be handled in a coordinated attack, shortly before or after a pesticide treatment. The entire household's laundry should be securely tied into plastic bags all at one time, and brought back into the home only after the living space has been treated. Dry cleaners should be informed of an infestation, and items should be properly bagged when delivered to a dry cleaning service. Laundered objects should be encased in securely tied garbage bags until they reach the laundry machine, and the bags should be discarded. Whenever practical, hot water and a 120° F (49° C) drying session extended by a few extra minutes are preferred. As extensive laundering of clean clothes may pose an excessive cost for some, drying clothing alone is completely effective in killing all stages. Laundering the clothes is then an aesthetic that makes some people feel better, but it is not necessary if the drying is done at medium to high heat for at least 20 minutes. Allow for time for the dryer to heat the clothes as the 20 minute to kill all stages is at the medium to high heat as noted above.

Steam Treatment - Some pest control firms offer steam treatment for mattresses or upholstered furniture. This is completely ineffective, since live steam must be directed onto every surface of an infected bed and its environs. Most people confuse water vapor (which is visible, as in clouds) and steam (which is invisible). The sight of clouds of water vapor emanating from a nozzle provides a mostly cosmetic and placebo effect; once the steam is condensed into water vapor, it has lost 95% of its heat to the surrounding air, and has virtually no effect on bacteria or other hardy creatures nearby. The only effective portion of the steam cleaner is the inch or so directly in front of the nozzle where the steam is invisible, and this needs to be directed onto a surface (or a bedbug or bedbug egg) for sufficient time to actually kill the organism. Indeed, the deposition of water vapor onto surfaces probably aids in bacterial growth, since moisture is essential for many bacterial metabolic processes. Directing live steam into cloth will result in water-soaked cloth, and is that really what we are after here?

After the mattress and/or box spring or futon has been treated, placing these inside a cotton or a polyvinyl or polyethylene bag is a good idea as a secondary means of defense. Bedbugs like to hide near the victim and are commonly found on seams of mattresses, or within the structure of box springs. The mattress bag serves to reduce this likelihood and in the case of box springs, it seals any remaining insects inside the bag. The mattress bag also protects the mattress from the mess of staining caused when bedbugs aggregate on seams. The bag is a good idea either until the infestation has been totally eliminated or in the case of good quality cotton bags, useful as a permanent protection for the mattress - and also to enable easier control if infestation recurs.

It may be your best option to dispose of all contaminated bedding, including the bed. Be careful to seal the mattress and bedding carefully inside a suitable (commercially available) mattress bag to avoid spreading bedbugs or their eggs while physically removing the articles. Have the room professionally treated before bringing in your replacements.

Treatment: Exterminators will often apply a "contact kill" spray directly on bedbugs found in the apartment (such as a mixture of cyfluthrin, pyrethrins, and piperonyl butoxide), and then spray lambda-cyhalothrin on baseboards and other favorite hiding places. Lambda-cyhalothrin acts as a "slow kill" barrier which kills bedbugs after they cross it, and is usually microencapsulated, making it safe to pets and humans after it dries. Often, deltamethrin is also injected into larger crevices. The lambda-cyhalothrin and the deltamethrin are at their strongest for the first two weeks following their application, but usually retain effectiveness for up to 60 days.

Gentrol and Phantom can also be used for bed bug control. Gentrol contains the active ingredient (S)-Hydroprene, an insect growth regulator (IGR) that disrupts the normal growth development of cockroaches and stored product pests, drain flies and fruit flies, as well as bed bugs. Phantom® uses an active ingredient known as chlorfenapyr. It is non-repellent and relatively long-lasting.

Successful treatment of a bedbug infestation is often highly dependent on how thorough the pest control professional is. Although the assessment and judgment of the pest control professional should be respected, most treatments cover such areas within domiciles as closets, curtains, outside and inside furniture crevices (dresser and desk drawers, night tables, etc.), as well as the interior of electrical outlets and behind pictures hangings on walls. If the choice was made to retain bedding, professionals will often either treat or steam-clean bed frames and the undersurface of solid beds. Some higher-end pest control firms also offer to perform the aforementioned vacuuming.