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Apps are also redefining concepts of “local” by facilitating connections between partners who live in very close proximity, such as the same condominium complex, as well as partners who live far apart and happen to be in close geographic proximity while one or both partners are away from home.In short, how individuals navigate their sexual lives is shifting with technology, information, and culture.The University of Toronto Research Ethics Board approved this study (protocol 32953).Toronto is the largest city in Canada (2011 population, 2.6 M; metropolitan area, 5.5 M), the fourth largest metropolitan area in North America, and the most multicultural city in the world.

Reasons for the persistence of these epidemics are unclear because of the complex biological, behavioral, social, cultural, structural, environmental, and spatial mechanisms—and interactions between these mechanisms—that create a “system” within which STIs persist and circulate in a population.

For context, Toronto has a very high immigrant population, very low crime rates (especially compared to other North American cities), universal access to health care, and a comprehensive transit and bicycle system.

Toronto also has the highest child poverty rate (note that overall Canada is a wealthy country) and second highest unaffordable housing rate in the country.

All hosters and rovers, and to a lesser extent, geoflexibles, reported a history of syphilis and human immunodeficiency virus.

From the Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada Source of Funding: Funded in part by Canadian Institutes of Health Research funding reference number 492948. Correspondence: Dionne Gesink, Ph D, Dalla Lana School of Public Health, University of Toronto, 155 College St, Toronto, Ontario, Canada M5T 3M7. Received for publication September 23, 2017, and accepted October 18, 2017.

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