The origins of the renaissance cittern lie in the medieval citole, an instrument which Tinctoris in his “De inventione et usu musicae” (ca. 1487) describes as being invented in Italy, having a flat body, fitted with fixed frets, strung with brass and steel strings and tuned to the intervals of a whole tone, fourth, whole tone and played with a plectrum. This already shows many of the characteristics of what Michael Praetorius in 1619 describes as the “old Italian” cittern, which by the beginning of the 16th century had increased the number of its strings from 4 single strings to 6 courses (sets of 2-3 strings), now tuned a/a, c'/c', b/b, g/g'/g', d'/d', e'/e'. These corresponded to the 6 notes of the hexachord, the basic building block of renaissance music theory.

Outside of Italy a four course "French cittern" tuned a/a'/a', g/g'/g', d'/d', e'/e', became the dominant form and this being the instrument called for in the earliest surviving cittern source from Elizabethan England, the Mulliner Manuscript (ca. 1560).

A notable innovation can be seen in Paolo Virchi 1574 publication “Primo Libro….Di Citthari”, with its use of a fully chromatic instrument. Earlier citterns both in and outside of Italy had used “diatonic” fretting, which entirely omitted the fourth fret and used a  number of the partial frets did not cross the entire fingerboard, thus making some notes unplayable.

The late Elizabethan cittern (tuned b/b, g/g'/g', d'/d', e'/e' ) as used by Anthony Holborne in his 1597 “Cittharn Schoole” or Thomas Morley’s 1599 “The First Booke of Consort Lessons” combines elements of the 4 course continental cittern with the tuning and chromatic fretting of late Italian instruments.